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THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 

MRS.  PRUDENCE  W.  KOFOID 


Boston,  June  12th,  1861. 

My  dear  Sir  : 

When  I  saw  you  last  week,  you  told  me  your  Committee  were 
collecting  books  for  distribution  among  our  soldiers.  After  I  left  you, 
it  occurred  to  me  that  I  might  contribute  somewhat  to  your  stock. 
The  result  is,  that  I  send  you  some  books,  —  medical  books,  —  to  be 
distributed  among  the  surgeons  of  the  regular  army. 

You  know,  that  a  few  years  ago,  I  published  "  Letters  to  a  Youn<j 
Physician"  and  that  a  month  ago,  I  published  another  letter,  icith  some 
other  medical  papers.  In  these  books  I  have  given  some  of  the  results 
of  a  long  experience  in  medical  practice.  With  surgery  I  do  not  med- 
dle ;  but  our  army  surgeons  have  much  to  do  in  the  strictly  medical 
line.  I  do  not  anticipate  a  full  confirmation  of  the  opinions  I  have 
advanced.  No  doubt,  if  I  were  to  live  fifty  years  longer,  I  should  alter 
some  of  them.  But  I  have  endeavored  to  be  correct.  I  have  urged 
very  strongly  the  importance  of  active  treatment  on  the  first  day  of  an 
acute  disease,  and  the  disadvantage  of  such  treatment  after  the  second, 
<jr,  at  the  latest,  the  third  day.  Now  it  would  seem  that,  in  army  and 
naval  service,  the  medical  man  might  ordinarily  be  able  to  commence 
the  treatment  of  acute  diseases  in  their  earliest  stages.  I  am  perfectly 
assured  that  it  would  be  very  advantageous  to  the  subjects  of  his  care, 
that  he  should  do  so  ;  though  they  might  not  always  reahze  the  benefit. 

With  this  I  shall  send  you  two  boxes  of  the  books  above  mentioned. 
I  wish  that  these  may  be  oft'ered  to  the  medical  officers  of  the  regular 
army  of  the  United  States.     If  more  are  wanted,  I  will  supply  them. 

I  wish  that  a  copy  of  this  note  may  be  given  to  every  surgeon  to 
whom  the  books  are  given,  and  on  that  account  I  shall  have  it  printed. 

I  am,  my  dear  sir, 

With  sincere  affection, 

Your  old  friend, 

JAiVlES   JACKSON. 

To  tin-  Rev.   ('hahlp:s  F.   Barxahd. 


%1^  6^t^ 


ANOTHER    LETTER 


TO    A 


YOUNG    PHYSICIAN: 


TO    WHICH    ARE    APPENDED 


SOME  OTHEK  MEDICAL  PAPEES 


BY 


JAMES   JACKSON,   M.  D., 

Professor    Emeritus    of   the  Theory  and   Practice  op  Medicixb 
IN  Harvard  University. 


BOSTON: 

TICKNOR    ^IN^D    FIELDS. 
1861. 


Entered  according  to  Act  of  Congress,  in  the  year  1861, 

By    JAMES     JACKSON, 

In  the  Clerk's  Office  of  the  District  Court  of  the  District  of  Massachusetts. 


CAMBRIDGE: 

MILES    &    DILLINGHAM, 
Printers  and  Stereotypers . 


CONTENTS. 

t 

Page 

Letter   XVIII., 1 

Notes,           .......  95 

Note     I.     John  Lowell,       ....  101 

"       II.     Extract  from  Letter   to  Dr. 

Forbes, Ill 

"     III.     Rebecca  Taylor,     .         .         .  118 

"     IV.     Mr.  Prescott,       ....  130 
Memoir  on  the  Sickness  and  Death  of 

General  Washington,        .  157 


ivi.'ld^QK.^ 


PREFACE. 

A  FEW  years  since  I  published  a  book 
entitled  "  Letters  to  a  Young  Physician." 
I  did  this  with  some  hesitation,  fearing 
that  I  was  too  old  to  venture  on  any  work 
for  the  public.  Nevertheless,  I  have  now 
taken  courage  to  prepare  one  more  letter. 
Probably  I  should  not  have  done  this,  if 
that  book  had  not  been  very  kindly  re- 
ceived. Emboldened  by  that  reception,  I 
have  more  than  once  had  it  in  my  mind 
to  write  one  or  more  letters  on  subjects, 
which,  from  time  to  time,  have  engaged  my 
attention.  But  on  reflection  I  have  thought 
it  wiser  to  leave  the  work  to  younger  and 
abler  men.  Within  the  last  year  a  grave 
question  has  been  agitated  among  us,  on 
which  one,  whose  experience  has  extended 

a*  [vj 


VI  PREFACE. 

through  more  than  half  a  century,  may  be 
thought  qualified  to  form  an  opinion. 

The  question  is  whether  there  is  any 
good  to  be  derived  from  the  practice  of 
medicine.  Our  public  in  this  little  Com- 
monwealth of  Massachusetts  was  led  to 
this  question  by  the  discourse  delivered 
before  our  Medical  Society  at  their  annual 
meeting  in  May,  1860,  by  Oliver  Wendell 
Holmes,  M.  D.  Whatever  is  said,  or  written 
by  that  gentleman,  will  always  produce  an 
impression  among  us,  and  probably  in 
other   parts  of  the  world. 

Dr.  Holmes  did  not  present  the  question 
as  I  have  stated  it  ;  but  the  matter  has 
been  treated  as  if  he  had  done  so.  At 
least,  some  of  our  brethren  have  regarded 
him,  as  denying  the  utility  of  our  art,  and 
it  was  so  understood  by  many  persons  not 
of  the  medical  profession.  It  is  because 
this  question  has  been  before  the  public 
that  I  have  prepared  the  following  letter. 
It  may  be   admitted    as  some  apology  for 


PREFACE.  VU 


offering  my  thoughts  upon  this  subject, 
that  a  large  proportion  of  the  present  fathers 
and  leading  practitioners  of  medicine  in 
our  Commonwealth  were  pupils  in  our 
principal  Medical  School,  while  I  was  a 
professor  there. 

In  regard  to  Dr.  Holmes,  it  has  seemed 
to  me  that  he  was  misunderstood  by  those, 
who  suppose  that  he  maintained  the  nega- 
tive upon  the  question  above  stated.  His 
great  object  was  to  inculcate  caution  in  the 
practice  of  medicine.  He  placed  in  a  strong 
light  the  evils,  which  may  be  occasioned 
by  the  action  of  potent  drugs  upon  a  living 
body.  He  urged  us  to  put  a  reliance  on 
nature  and  to  pursue  what  has  been  called 
the  expecta7it  plan  of  treating  the  sick  in 
all  cases,  where  the  evidences  in  favor  of 
some  active  practice  are  not  clearly  shown 
by  experience. 

Without  discussing  precisely  the  opinions 
advanced  by  my  learned  friend,  I  have  met 
the   question,    which  has  in  fact  been  en- 


Vlll  PREFACE. 

tertained  among  us  since  the  delivery  of 
his  discourse.  And  in  regard  to  this  ques- 
tion I  have  not  taken  a  side  for,  or  against, 
the  utility  of  medicine,  in  the  style  of  a 
partizan.  The  stand  I  take  is  somewhat 
that  of  a  witness,  called  upon  in  the  char- 
acter of  an  expert. 

I  trust  it  will  be  found  that  I  have 
given  my  testimony  fairly,  with  a  regard 
to  the  oath  that  a  witness  is  supposed  to 
take.  So  far  as  it  goes,  I  believe  that  this 
testimony  will  afford  some  support  to  the 
claims  of  medicine  to  be  a  useful  art.  I 
do  not  deny,  but  affirm  that  our  art  is  im- 
perfect. Taking  the  cases  of  disease  as 
they  are  brought  to  us,  it  is  not  often  that 
we  are  justified  in  employing  heroic  prac- 
tice. But  much  may  be  done  without 
adopting  this  practice.  When  a  surgeon 
is  called  to  a  man  with  a  broken  leg,  he 
places  the  limb  of  his  patient,  and  in  some 
measure  his  whole  body,  in  a  fixed  position, 
using  splints  and  bandages ;  and   then  he 


PREFACE.  IX 

watches  him  from  day  to  day.  He  does 
not  pretend  that  the  processes  of  healing  in 
the  fractured  bone  are  brought  into  opera- 
tion by  the  splints  and  bandages,  nor  by 
his  watching.  But  he  has  placed  the  in- 
jured parts  under  the  circumstances  most 
favorable  for  healing ;  and  he  watches  that 
he  may  guard  against  everything,  which 
can  interfere  with  the  salutary  operations 
of  nature,  as  well  as  that  he  may  give  to 
her  any  support,  w^hich  he  may  think  that 
she  needs.  Just  so,  the  physician,  in  the 
larger  number  of  cases  under  his  care,  makes 
it  his  business  to  dispose  of  everything  re- 
lating to  his  patients  in  such  a  manner,  as 
to  give  the  best  chance  for  the  salutary 
operation  of  the  natural  powers.  A  good 
nurse,  it  may  be  said,  may  do  the  same. 
But  the  qualifications  of  a  well-educated 
physician  must  enable  him  to  take  the  care 
with  much  greater  advantage. 

I  have  not   followed   any  strict  method 
in  this  letter.     After  some  introductory  re- 


PREFACE. 


marks  I  have  named  several  of  the  most 
powerful  articles  of  the  materia  medica, 
which  are  in  use  among  us,  and  some  minor 
articles  analogous  to  each  of  them  respec- 
tively, and  have  stated  in  regard  to  each 
what  value  I  attach  to  them.  In  doing 
this  I  have  necessarily  mentioned  the  dis- 
eases, in  which  I  have  found  them  bene- 
ficial. Next,  turning  to  the  most  prominent 
of  the  diseases  we  meet  with,  the  acute 
diseases  particularly,  I  have  stated  in  which 
of  these,  and  under  what  circumstances,  I 
have  found  benefit  from  the  employment 
of  powerful  remedies.  While  expressing 
my  opinions  on  these  topics  I  have  allowed 
myself  to  go  into  details,  whenever  I  deemed 
this  might  be  useful.  Indeed,  when  stating 
that  benefit  may  be  expected  from  the  use 
of  a  medicine  in  a  particular  disease,  it  is 
often  quite  necessary  to  say  in  what  way 
the  drug  must  be  prepared,  and  under  what 
conditions  it  should  be  given. 

In  writing,  I  have  had   in    view  princi- 


PREFACE.  XI 


pally  my  brethren  in  New  England,  and 
especially  the  Fellows  of  the  Massachusetts 
Medical  Society.  Indeed,  I  have  felt  almost 
as  if  preparing  a  circular  letter  to  these 
Fellows. 

To  this  eighteenth  letter  some  articles 
are  added  which  w^ill,  I  hope,  be  read  with 
interest  by  medical  men,  and  not  be  without 
some  attraction  for  general  readers  in  the 
region  about  Boston. 

The  critic  may  note  in  this  book  the 
garrulous  tendency  common  in  old  age.  If 
he  cannot,  I  can.  I  claim  the  apology, 
which  the  aged  may  always  offer  in  such 
a  case.  When  a  traveller  returns  home,  he 
has  a  right  to  suppose  that  his  friends  and 
neighbors  w^ill  like  to  hear  what  he  can 
tell  of  foreign  parts.  Just  so,  old  men  and 
old  women  are  justified  in  the  belief  that 
the  young  will  be  glad  to  hear  anecdotes 
of  old  times  and  notices  of  the  people  who 
were  cotemporaries  of  their  grandfathers. 
The    travellers    through    the   bygone  years 


Xll  PREFACE. 


and  in  the  foreign  countries,  are  both  right. 
The  care  should  be  not  to  spin  out  their 
stories  to  too  great  a  length. 

Boston,  March  29,  1861. 


LETTER  XVIII. 

ON    THE    UTILITY    OF    MEDICINE. 

In  my  former  letters  I  discussed  questions  of 
practice,  referring  to  first  principles  occasionally, 
as  far  as  seemed  necessary  to  explain  my  views 
on  practical  matters.  Now  I  turn  to  first  prin- 
ciples—  fundamental  principles.  Do  not  be  sur- 
prised, however,  if  I  seem  to  forget  what  I  had 
set  about,  so  as  to  run  off  continually  to  the 
consideration  and  statement  of  little  details  as  to 
practice.  I  know  my  own  tendency  in  this  par- 
ticular. The  truth  is  that  I  consider  it  very 
dangerous  to  lay  down  first  principles  in  any  art, 
without  a  nice  regard  to  the  limitations  of  those 
principles,  when  applied  to  the  art  concerned. 
Listen  a  minute  to  an  anecdote  which  I  heard 
long  ago,  and  which  made  a  very  strong  impres- 
sion on  my  mind.  Roger  Sherman  of  Connecticut, 
one  of  the  Committee  who  drew  up  the  Declaration 
of  Independence  in  1776,  was  not  a  graduate  of 


Z  ON    THE    UTILITY    OF    MEDICINE. 

any  college.  lie  began  life  as  a  shoemaker ;  but 
lie  had  a  mind  fitted  by  nature  for  deep  thought. 
About  the  year  1793,  when  he  was  a  member  of 
the  Senate  of  the  United  States,  on  some  occasion, 
not  one  of  the  greatest  importance,  he  addressed 
the  higlily  respected  members  of  that  grave  body, 
proposing  to  them  some  measure  which  he  moved 
them  to  undertake.  In  doing  it,  he  was  extremely 
exact  and  cautious  in  describing  the  limitations  to 
be  regarded  in  bringing  his  principles  into  practice. 
He  carried  his  caution  so  far  as  to  amuse  one  of 
his  friends  and  fellow  Senators,  who  told  the  story 
to  me,  and  who  afterwards  asked  him  why  he 
was  so  careful  in  this  instance.  His  reply  was 
to  this  effect,  —  the  laying  down  general  princi- 
ples is  hke  building  a  stage,  on  which  you  are 
to  take  your  stand.  You  must  be  cautious  in 
building  it ;  for  if  you  make  it  too  large,  or 
without  proper  limitations,  your  opponents  will 
have  a  chance  to  get  upon  it,  and  drive  you 
off. 

The  question  I  am  about  to  consider  is,  how 
far  the  sick  are  benefited  by  the  care  and  pre- 
scriptions of  the  physician  ;  —  or,  limiting  the 
inquiry  to  the  use  of  medicinal  drugs,  —  whether 
the  sick  are  more  helped  than  hurt  by  them. 


ON    THE    UTILITY    OF    MEDICINE.  O 

Scepticism  in  the  art  of  medicine  is  not  new. 
Probably  it  has  existed  from  the  days  of  Hip- 
pocrates ;  at  any  rate,  I  know  that  it  has  existed 
as  long  as  I  have  been  engaged  in  professional 
hfe;  which  means  for  a  term  of  sixty  years. 
Sometimes  the  wits  have  laughed  at  the  doctors ; 
sometimes  the  philosophers  have  called  them  into 
the  court  of  science,  there  to  show  cause  why 
they  should  not  abandon  the  use  of  powerful 
drugs  altogether;  urging  that  such  dinigs  mani- 
festly do  harm ;  and  that  they  were  bound  to 
show  that  the  benefit  from  them  was  greater  than 
the  evil.  In  truth,  it  has  not  been  very  uncom- 
mon, for  an  old  practitioner  of  medicine  himself, 
to  avow  his  doubts  as  to  the  real  benefits  to  be 
derived  from  the  treatment  of  diseases  by  heroic 
remedies. 

If  the  question  were  as  to  the  soundness  of  any 
system  of  medicine,  old  or  new,  I  should  always 
take  my  place  among  the  sceptics.  It  is  quite 
certain  that  more  is  required  to  make  a  system  of 
medicine  satisfactory,  than  can  be  furnished  from 
our  present  stock  of  knowledge ;  although  it  is 
certainly  true  that  we  are  better  prepared  than 
any  of  our  predecessors.  Before  we  can  make  a 
system  of  rational  medicine,  our  stock  of  knowl- 


4  ON    THE    UTILITY    OF    MEDICINE. 

edge  must  be  increased  in  all  and  each  of  the 
various  departments  of  our  science.  First,  our 
physiology  must  be  perfected  in  all  its  details ;  in 
regard  to  the  elements  of  the  human  body,  its 
structure,  the  powers  belonging  to  its  various 
parts,  the  functions  performed  by  each  of  these 
parts,  &c.  Secondly,  we  must  understand  how, 
or  in  what  mode  foreign  agents  act  on  the  living 
body ;  in  what  way  they  do  good,  and  in  what 
way  they  do  harm.  We  should  be  able  to  ascer- 
tain when  such  agents  modify  the  functions  only, 
and  when  they  lead  to,  or  induce  changes  in  the 
structure  of  the  part  they  act  on.  We  must  be 
able  to  ascertain  whether  there  are  any  natural 
processes,  by  which  disease  is  removed  ;  and,  if 
so,  in  what  cases  this  happens,  and  in  what  it 
does  not ;  and  when  there  are  not  any  such 
natural  processes,  we  should  be  able  to  point  out 
modes  of  obviating  the  evils  of  the  disease,  the 
remedies  which  nature  has  furnished  for  this  pur- 
pose, and  their  modus  operandi.  Such  is  a  brief 
and  imperfect  sketch  of  what  is  required  to  make 
up  a  system  of  medical  science.  In  all  ages  efforts 
to  attain  this  purpose  have  been  made  ;  and  ac- 
cordingly systems  more  or  less  elaborate  have 
been  devised  and  published.     Some  of  them  have 


ON    THE    UTILITY    OF    MEDICINE.  O 

been  adopted  by  the  learned,  and  been  the  sub- 
jects of  temporary  admiration  and  confidence. 
But  no  one  of  them,  up  to  this  time,  has  stood  its 
ground  after  a  full  and  thorough  trial  of  it.  The 
wisest  and  soundest  practitioners  have  never 
placed  their  reliance  on  these  systems,  or  not 
long.  In  all  ages,  such  practitioners  have  looked 
to  experience,  and  been  guided  by  tliis  in  the 
treatment  of  the  sick.  And  let  me  ask  if  there 
be  any,  among  the  useful  arts,  in  which  the  same 
is  not  true.  But  the  knowledge  derived  from 
this  source  comes  slowly  and  with  difficulty.  It 
certainly  has  not  yet  led  us  to  modes  of  practice, 
which  are  entirely  satisfactory  in  all  instances  ; 
and  the  bold  and  the  enterprising,  in  attempting 
to  gain  the  requisite  knowledge  more  rapidly, 
have  too  often  inflicted  as  many  evils  as  they 
have  removed. 

Many  men,  in  and  out  of  our  profession,  believe, 
or  seem  to  beHeve,  that  disease  must  always  be 
removed  by  medicines,  ignoring  in  a  good  measure 
the  spontaneous  efforts,  by  which  disease  is  brought 
to  a  happy  termination  in  a  large  proportion  of 
cases.  These  remarks  are  not  new  ;  but  I  think  it 
may  be  said  that,  at  this  time,  there  is  a  tendency 
on  this  side  of  the  Atlantic   and   on  the  other,  to 


6  ON    THE    UTILITY    OF    MEDICINE. 

more  rational  opinions  on  this  subject.  At  the 
last  annual  meeting  of  the  Massachusetts  Medical 
Society,  Dr.  Holmes,  the  distinguished  Professor 
of  Anatomy  and  Physiology  in  our  medical  school, 
delivered  a  discourse,  in  which  the  evils  of  over 
medication  were  portrayed  in  strong  colors.  I 
shall  keep  this  discourse  in  view,  while  I  offer 
the  results  of  my  own  observations  and  experience 
on  the  utility  of  medicinal  drugs  in  the  treatment 
of  the  sick.  I  wish  to  draw  your  attention  to 
the  limits,  which,  in  the  present  state  of  our 
knowledge,  should  be  put  to  the  use  of  these 
drugs.  This  is  a  large  subject ;  and  I  do  not 
dream  of  treating  it  fully  and  accurately.  But 
I  hope  at  least  to  offer  some  useful  hints  ;  and 
while  thus  engaged,  I  shall  avail  myself  of  any 
fit  opportunity  for  practical  remarks  on  the  treat- 
ment of  the  sick. 

An  impression  has  been  received,  in  and  out 
of  our  profession,  that  Dr.  Holmes  meant  to  rep- 
resent the  medical  art  as  useless,  and  even  as 
productive  of  evil,  at  least  so  far  as  the  adminis- 
tration of  medicine  is  concerned.  Somewhat  simi- 
lar opinions  have  been  formed,  by  some  persons, 
in  respect  to  the  faith  of  my  learned  fi-iend,  Dr. 
Jacob  Bigelow,  in  the  utility  of  our  art.     I  do 


ON    THE    UTILITY    OF    MEDICINE.  < 

not  understand  that  eitlier  of  these  gentlemen  is 
thus  sceptical.  Tliey  may,  or  may  not  place  less 
confidence  in  the  utility  of  the  practice  of  medicine 
than  I  do.  One  hardly  finds  two  men,  who  agree 
exactly  on  any  practical  question,  though  it  be 
one  with  which  both  are  conversant.  I  am  happy 
to  say  that  I  accord  generally  with  the  opinions 
expressed  in  the  writings  of  my  two  fi-iends.  I 
go  with  them  in  what  may  be  called  their  con- 
servative opinions.  I  have  held  the  same  for 
many  years.  Nearly  twenty  years  ago  Sir  John 
Forbes  published  a  review  on  the  subject  of 
homoeopathy,  in  which  he  reprobated  excessive 
medication.  Immediately  upon  reading  this  re- 
view I  wrote  him  a  letter,  designed  to  be  pnvate 
only,  expressing  thoroughly  and  clearly  my  agi'ee- 
ment  with  him.  Some  extracts  from  this  letter 
he  published  in  the  next  number  of  his  review, 
where  it  remains  to  testify  to  my  opinions  at  that 
time.  But  my  objections  then,  as  now,  were  to 
the  abuses  of  medicine.  That  I  have  faith  in  the 
usefulness  of  our  profession  and  in  the  benefits 
to  be  derived  from  medicinal  drugs,  I  have  shown 
in  the  preceding  letters  published  in  1854.  I 
am  not  aware  of  anything  in  those  letters  which 
I  wish  now  to  retract.     It  is  the  errors  and  abuses 


8  ON    THE    UTILITY    OF    MEDICINE. 

in  medical  practice,  against  Avliich  the  three  gen- 
tlemen, above  named,  have  made  war.  The  errors 
and  abuses  consist  in  the  constancy,  with  which 
medicine  is  administered  in  all  diseases  and  in  all 
stages  of  disease,  in  the  undue  strength  and  doses  of 
the  drugs  employed,  and  above  all  in  the  disregard 
of  the  spontaneous  efforts  for  relief  by  natural  pro- 
cesses, and  the  neglect  of  hygienic  principles  in 
the  treatment  of  the  sick.  It  is  said,  on  the  other 
side,  that  the  sick  are  often  unhappy,  if  medicinal 
remedies  are  not  ordered  for  them.  It  is  true, 
in  many  instances,  M^ien  medicine  is  not  pre- 
scribed for  a  sick  man,  even  one  who  is  intelligent, 
that  he  complains  that  the  physician  does  not 
order  anything  for  the  removal  of  the  principal 
pain,  or  trouble  for  which  his  aid  had  been  in- 
voked. But,  in  the  great  majority  of  cases, 
though  not  in  all,  I  have  found  that  a  plain  state- 
ment of  the  truth  would  satisfy  the  complainant ; 
would  satisfy  him,  I  mean,  that  the  physician 
was  taking  the  best  course.  In  connecti(m  with 
the  foregoing  I  wish  to  state,  emphatically,  two 
principles,  which  I  should  be  very  glad  to  engrave 
on  the  memory  of  every  medical  man,  and  of  all 
men,  who  may  wish  to  derive  benefit  from  the 
care  of  medical  men.     The  first  is  that  it  is  at 


ON    THE    UTILITY    OF    MEDICINE.  9 

the  very  commencement  of  a  disease  that  there  is 
the  best  chance  of  arresting,  or  mitigating  it  by 
treatment.  Patients  have  sometimes  said  to  me 
that  they  had  not  sent  for  me  a  day,  or  a  week 
sooner,  because  they  did  not  know  what  was  the 
matter  with  them,  or  how  the  disease  was  brought 
about.  To  this  I  have  repHed  by  asking  if  your 
house  were  on  fire,  would  you  delay  calling  for  the 
firemen,  till  you  found  out  how  and  where  the 
fire  originated?  In  truth  the  ignorance  on  the 
part  of  the  patient,  as  to  the  nature  of  the  disease 
and  its  cause,  should  be  regarded  as  the  best 
reason  for  asking  a  physician's  advice  without 
delay.  The  other  principle  is  that  when  medicinal 
drugs  cannot  be  employed  with  benefit,  medical 
treatment  may  nevertheless  be  very  useful.  It 
is  by  hygienic  treatment  that  the  sick  may  be 
relieved,  in  many  instances,  especially  when  em- 
ployed in  the  first  stage  of  disease.  In  truth  the 
wisest  course  for  a  sick  man,  who  can  have  re- 
course to  a  physician,  in  whom  he  has  confidence, 
is  to  call  for  professional  aid  as  soon  as  he  finds 
himself  sick  ;  —  and  this,  all  the  more,  if  he  does 
not  understand  his  own  case.  Having  called  his 
physician,  the  patient  should  submit  himself  to 
his  control  entirely,  allowing  him  to   delay  any 


10  ON    THE    UTILITY    OF    MEDICINE. 

active  treatment,  in  order  to  watcli  the  course 
of  the  disease,  as  long  as  he  pleases  ;  or,  on  the 
other  hand,  to  resort  at  once  to  the  use  of  such 
active  and  powerful  measures,  as  he  may  think 
proper.  If  the  patient  cannot  tiTist  the  phy- 
sician so  much  as  this,  he  had  better  not  employ 
him. 

Let  us  now  return  to  Dr.  Holmes'  discourse. 
The  great  principle  which  he  endeavors  to  im- 
press on  the  minds  of  his  brethren  is  this  ;  —  that 
medicinal  drugs,  generally,  are  articles  which  have 
some  noxious  influence  on  the  person,  to  whom 
they  are  administered.  He  does  not  deny  that 
they  may  be  serviceable,  but  maintains  that  it  is 
the  duty  of  the  physician,  when  administering 
them,  to  compare  the  possible  evil,  which  may 
be  produced,  with  the  benefits  which  he  is 
justified  in  expecting  from  it.  So  far  nothing 
new  is  offered  to  the  mind  of  the  physician ;  but 
this  necessary  caution  may  be  more  deeply  im- 
pressed upon  his  mind  by  this  forcible  inculcation 
of  it.* 

*  Let  me  here  refer  the  reader  to  my  introductory  letter  in 
the  "  Letters  to  a  Young  Physician."  See  there,  at  page  13,  a 
paragraph  beginning  on  the  eighth  line,  and  also  the  paragraph 
following  that  which  terminates  on  the  loth  page. 


ON    THE    UTILITY    OF    MEDICINE.  11 

We  are  questioned  daily,  especially  by  timid  or 
cautious  patients,  whether  the  taste  of  the  medicine 
proposed  will  not  be  offensive,  whether  it  will  not 
give  cause  for  pain  or  distress,  and  whether  it  will 
not  be  productive  of  weaknass,  or  of  other  evils. 
On  these  points  the  physician  answers,  as  the  case 
may  be,  that  indeed  such  and  such  evils  may  be 
produced,  but  he  states  that  in  his  opinion  the 
benefits  will  be  greater  than  the  evil  consequences, 
else  he  would  not  make  the  prescription.  Though 
a  conversation  like  this  does  not  occur  in  every 
instance,  yet  it  is  presumed  that  the  prudent  phy- 
sician does  always  have  these  questions  in  his 
mind,  and  that  he  would  not  make  his  prescrip- 
tion, if  he  did  not  think  the  chance  of  evil  much 
less  than  that  of  good.  But  Dr.  H.  wishes  his 
medical  friends  to  look  at  this  subject  with  pecuHar 
care,  and  he  fears  that  there  are  some  among  us  at 
least,  who,  being  accustomed  to  the  use  of  power- 
ful medicines,  become  forgetful  of  the  grave  and 
injurious  consequences  to  which  they  tend,  or 
which  at  least  they  may  produce.  He  brings  be- 
fore us  a  statement  of  the  evils  in  a  numerical 
form.  Supposing  the  vital  power  to  be  represent- 
ed by  100,  he  estimates,  by  way  of  example,  the 
e\'il  occasioned  by  the  medicine  employed  at  five 


12  ON    THE    UTILITY    OF    MEDICINE. 

per  cent.  ;  and  then  it  follows  that  twenty  such 
doses  would  take  away  all  the  vital  power ;  that 
is,  it  would  destroy  the  life  of  the  patient.  This 
must  follow  on  the  supposition  ;  but  we  may  ask 
Dr.  H.  if  he  has  not  made  a  very  violent  supposi- 
tion. It  is  by  the  way  of  example  he  states  the 
risk  at  five  per  cent.  ;  but,  when  one  makes  such  a 
statement,  it  is  presumed  he  will  take  an  instance 
witliin  ordinary  limits.  It  is  undoubtedly  true 
that  ignorant  and  rash  men  may  often  subject 
their  patients  to  such  a  risk.  It  is  true  that  a 
wise  and  prudent  physician  will  sometimes  do  the 
same,  when  he  thinks  the  risk  of  death  from  the 
disease  is  very  great.  Surgeons  perform  opera- 
tions every  day,  from  which  the  risk  to  life  is  very 
much  more  than  five  per  cent. ;  but  it  is  because 
the  risk  from  the  disease  is  forty,  sixty,  or  ninety 
per  cent.  But  it  is  very  rare  that  the  risk  to  life 
from  a  single  dose  of  medicine  amounts  to  one  per 
cent.  The  risk,  however,  from  a  continued  use  of 
a  powerful  drug  for  weeks,  or  months,  may  be  as 
much  and  a  great  deal  more  than  five  per  cent. 
This  risk  is,  I  fear,  sometimes  incurred  without 
sufficient  consideration.  We  can  all  see  that  in 
the  common  practice  of  the  last  age  such  a  risk 
was   incurred  too  frequently.     It  can  do  us    no 


ON    THE    UTILITT    OF    MEDICINE.  13 

hann  to  have  our  attention  strongly  directed  to 
the  subject,  so  as  to  lead  each  one  of  us  to  inquire 
whether  we,  at  the  present  day,  are  sufficiently 
cautious. 

When  Dr.  H.  spoke  of  sinking  all  the  drugs  in 
the  sea,  he  did  not  mean  to  be  very  literal.  If  we 
contemplate  the  act  proposed,  we  must  see  that  he 
must  be  more  of  an  autocrat  than  Peter  the 
Great,  Emperor  of  all  the  Russias,  before  he  could 
put  his  proposal  into  execution.  If  he  could  take 
up  all  the  mineral  medicines  in  the  market,  he 
could  not  take  away  the  demand  for  them  ;  and 
the  demand  would  bring  the  supply,  even  though 
that  supply  must  be  sought  for  in  the  deepest 
mines.  And  as  to  the  vegetable  and  animal 
articles  of  the  Materia  3Iedica,  if  he  should  empty 
the  shops  of  the  druggists  from  San  Francisco  to 
New  York,  it  would  only  insure  us  a  clean  stock 
the  next  year.  Our  friend  was  not  understood  to 
mean  literally  that  he  would  fill  up  the  Bay  of 
Massachusetts  by  pouring  into  it  all  the  drugs  in 
these  United  States.  But  I  do  understand  liim  to 
say  that  he  thinks  that  medicinal  drugs,  as  used 
in  this  country  and  in  Europe,  do  on  the  whole 
cause  more  harm  than  good.  Is  this  opinion 
strictlv  correct  ?     It  is  not  agreeable  to  make  such 


14  ON    THE    UTILITY    OF    MEDICINE. 

a  statement,  but  I  must  acknowledge  that  I 
have  been  in  the  habit,  for  many  years,  of  giv- 
ing advice  which  corresponds  with  this  opinion 
in  some  measure.  To  friends  about  to  travel 
whether  on  this  side  of  the  Atlantic  or  on  the 
other,  I  have  said,  "  Do  not  employ  any  physician 
unless  you  can  ascertain,  on  good  authority,  that 
he  is  regulai'ly  bred  and  likewise  has  the  character 
of  being  prudent  and  discreet."  I  agree  ftdly 
with  Dr.  Holmes  that  there  is  a  very  great  risk 
of  evil  from  active  practice,  conducted  by  persons 
imperfectly  qualified. 

The  chance  of  evil  resulting  from  an  indulgence 
in  the  use  of  alcohohc  beverages  is  analogous  to 
that  of  the  indiscreet  use  of  powerful  medicines. 
These  beverages,  used  with  discretion,  are  in  my 
opinion  blessings,  for  which  we  should  be  thankful ; 
but  it  would  be  difficult  to  state,  though  we  should 
employ  the  strongest  language,  how  great  are  the 
evils,  direct  and  indirect,  produced  by  alcohol  as 
actually  employed.  It  has  often  been  a  question  in 
my  own  mind,  whether  the  benefits  from  tliis  arti- 
cle could  be  as  great,  as  the  evils  connected  with  it. 
I  have  not  decided,  however,  that  discreet  men 
should  abandon  it  on  that  account ;  —  for  it  is  my 
belief  that  those  evils  could  not  be  prevented,  if 


ON    THE    UTILITY    OF    MEDICINE.  15 

every  discreet  man  on  the  earth  should  abstain 
from  using  it.  I  would  say  of  medicinal  drugs,  as 
I  do  of  alcohol,  that  prudent  men  need  not  hesitate 
to  employ  them,  because  other  men  make  an  im- 
proper use  of  them.  These  are  opinions  to  which, 
I  believe,  my  friend.  Dr.  Holmes,  would  give  his 
assent.  I  wish,  therefore,  to  be  understood  as 
being  of  the  conservative  party  in  respect  to  the 
use  of  medicine,  though  I  am  not  prepared  to  give 
it  up  altogether. 

Let  me  now  examine  these  powerful  medicinal 
dinigs  in  some  detail,  and  give  my  opinions  respect- 
ing their  value.  When  I  began  my  professional 
studies,  my  old  master,  pointing  to  the  numerous 
drawers  and  to  the  bottles  arranged  on  the  shelves 
in  his  shop,  said  to  me,  "  I  seem  to  have  here  a 
great  number  and  variety  of  medicines,  but  I  may 
name  four,  which  are  of  more  importance  than  all 
the  rest  put  together  ;  viz.  Mercury,  Antimony, 
Opium,  and  Peruvian  bark."  It  is  more  than 
sixty  years  since  this  statement  was  made  to  me  by 
my  respected  teacher.  From  that  time  to  this, 
scarcely  a  day  has  passed,  in  which  I  have  not 
seen  one,  or  more  of  these  articles  in  use  among 
the  sick.  What  is  my  experience  as  to  their 
value  ?      I    proceed    to    state   it   with    as   much 


16  02N     THE    UTILITY    OF    MEDICINE. 

fidelity  and  accuracy  as  I  am  capable  of.  Let  me 
ti'eat  of  each  of  the  four  articles  above  named,  in 
its  turn,  referring  at  the  same  time  to  others  having 
the  same,  or  similar  properties,  with  each  of  them 
respectively. 

To  the  first  two,  Mercury  and  Antimony,  as 
well  as  to  some  other  metallic  articles,  there  are 
certainly  grave  objections.  They  are  capable  of 
doing  great  mischief.  They  should  not  be  put 
into  the  hands  of  children,  nor  into  those  of  any 
ignorant,  or  unprincipled  men,  any  more  than 
gunpowder  or  bowie-knives.  But  I  should  be 
yerj  sorry  to  be  entirely  deprived  of  either  of 
them.  I  have  directed  the  use  of  them  for  my 
friends,  and  have  employed  them  on  myself,  when 
occasion  called  for  them ;  for  it  has  always  been 
my  nile  to  administer  to  my  patients  those  articles 
only,  which  I  would  employ  for  myself  under  like 
circumstances.  Following  this  rule,  I  should  wish 
to  keep  on  the  list  of  my  Materia  Medica  —  Mer- 
cury —  Antimony  —  Arsenic  —  and  some  other 
potent  metallic  medicines. 

Among  these  articles,  no  one  is  more  commonly 
viewed  with  abhorrence  than  Mercury.  It  is  well 
that  it  should  be  so.  It  has  been  used  within  the 
last  hundred  years  with  too  much  liberaHty,  and 


ON    THE    UTILITY    OF    MEDICINE.  17 

often   to  the  great  injury  of  the  sick.     Yet,  when 
employed    discreetly,   it   may   be   given    even    to 
children,  during  early  infancy,  during  the  period 
of  the  first  dentition.     For  them,  calomel   in    a 
single  dose,  may  often   be   employed  with  great 
relief,  and  with  more  advantage  than  any  other 
drug.     They  are  specially  subject  to  disorders  in 
the   first  passages,  and  by  it  these  may  be  cleared 
out  more  efficiently,  and  generally  with  less  incon- 
venience than  by  any  other  article.     But  the  use 
of  it  should  not  be  continued.     If  one   dose  seem 
to  have  removed  half  the  disease,  we  must  not 
expect  to  remove  the  other  half  by  a  second  dose. 
If    a    derangement    in   the    digestive   organs   has 
brought  about  a  necessity  for  the   administration 
of  it,  we  must  subsequently  insist  upon  such  care 
as  to  diet,  air,  exercise,  &c.,  as  ^\^ll  perfect  the 
cure,  and  will  prevent  the  recurrence,  certainly 
will  prevent  the  frequent  recurrence  of  the  same 
derangement,   for  which   the  medicine  had  been 
administered.     For  though  the  benefit  from  one 
dose  may  be  much  greater  than  the  evil  produced 
by  it,  yet  it  may  be  too  much  to  incur  the  risk  of 
this  evil   anew  every  few  days.     Calomel  should 
not  be  made  familiar  in  the  nursery,  as  a  con- 
venient brush  or  broom,  by  which  to  clean  up  that 
2 


18  ON    THE    UTILITY    OF    MEDICINE. 

apartment  as  often  as  the  children  have  got  it  dirty. 
I  give  this  caution,  for  this  reason.    Though  many 
mothers  have  a  fear  of  the  use  of  calomel  for  their 
children,  there  are  others  who  do  not  hesitate  to 
keep  it  on  hand,  and  to  administer  it  at  their  own 
discretion.     For  adults,  also,  this  article,  as  well 
as  the  blue-pill,  may  be  given  in  a  single  dose  with 
undoubted  advantage.     By  a  certain  class  of  per- 
sons it  is  regarded  with  great  favor  ;  by  those,  I 
mean,  who  indulge  their  appetites  too  freely.     But 
by  them  even,  although  they  may  generally  be  in 
vio-orous  health,  it  must  be  used  with  discretion. 
It  is  not  well  for  them  to  make  free  with  it.     The 
patient  who  begs  for  it,  will  be  greatly  vexed  if  it 
treat   him   roughly.     Early  in   life,  my  old    and 
much  respected  friend,  the  late  Dr.  James  Lloyd, 
told  me  the  story  of  a  case,  similar  to  what  may 
have  occurred  within  the  experience  of  many  of 
our  brethren.     A  hundred  years  ago,  Capt.  A.  B. 
havnig   a   severe    colic,    sought   relief    from    Dr. 
Clarke.     He  begged  the  doctor  not  to  be  sparing 
in  his  remedies,  to  give  him  the  most  powerful,  and 
those  in  the  fullest  doses.     He  demanded  heroic 
practice.     He  asked  for  calomel  especially,  from  a 
vague,  though  erroneous  notion,  that  it  was  the 
most  powerful  of  cathartics.     Dr.  C.  yielded  to  his 


ON    THE    UTILITY    OF    MEDICINE.  19 

solicitations,  and  after  due  time  obtained  relief  for 
his  patient ;  but,  within  two  days,  the  patient 
beoan  to  have  a  sore  mouth,  and  ultimately  the 
affection  of  his  mouth  was  so  severe,  that  for  sev- 
eral days  he  could  neither  eat,  nor  speak,  without 
great  distress.  The  captain  now  became  more 
impatient  under  the  new  disease,  than  he  had  been 
under  the  colic.  In  this  speechless  state  he  sat  at 
his  table,  and  gave  vent  to  his  feelings  by  writing 
every  few  minutes,  —  ''  Damn  Dr.  Clarke."  This 
poor  patient  realized  how  true  it  is  that  a  medicine 
may  do  a  certain  amount  of  harm,  which  is  to  be 
taken  into  the  calculation  when  the  physician 
attempts  to  do  good  with  it.  In  passing,  let  me 
here  remark  that  I  tliink  calomel  should  never  be 
employed  in  a  case  of  great  constipation  ;  for  in 
such  a  case,  if  it  be  not  effectual  at  once,  being 
retained  in  the  body,  it  is  very  likely  to  produce 
its  peculiar  effects  on  the  mouth.  Besides  this, 
calomel  is  not  the  best  medicine  for  removing  a 
great  constipation.  Its  peculiar  excellence  is  that 
it  acts  on  the  stomach,  and  the  upper  part  of  the 
intestines.  It  is  not  so  certain  as  some  other  arti- 
cles, to  induce  a  speedy  evacuation  of  the  whole 
canal.  But  I  will  not  go  on  to  mention  the 
occasions  proper  for  using  this  article  :  several  of 


20  ON    THE    UTILITY    OF  MEDICINE. 

these  have  been  noticed  in  the  preceding  letters. 
Of  course,  every  medical  man  knows  that  there 
are  occasions,  which  justify  the  use  of  mercurial 
preparations,  until  the  mouth  is  made  sore. 

I  mention  Antimony  next  to   Mercury.     In  a 
report,  made  more  than  twenty  years  ago,  upon 
Typhoid  Fever,  founded  on  cases  in  the  Massachu- 
setts  General    Hospital,  I  showed  what  benefits 
had  been  derived  from  the  use  of  this  article,  as 
an  emetic^  when  administered  on  the  first  day^  or 
even  within  the  first  three  days  of  that  fever.     I 
brought  up  this  subject  anew  in  the  17th  of  these 
letters.     It  is  because  I  think  it  for  the  common 
good   that   physicians    should   be  duly  impressed 
with  the   value  of  this  remedy  in  typhoid  fever, 
that  I  now  bring  the  subject  before  them  again. 
That   they  may  avail  themselves  of  it,    there    is 
one   point   to   be   studied,    which   I    fear    is   not 
always    studied    with    sufficient    care  and   exact- 
ness.    The   point  I  refer   to   is    the  diagnosis  of 
typhoid  fever  on  its  first  days ;  on  its  first  day^ 
if  possible.     I  will  begin  by  acknowledging  that 
on  the  first  day  of  this  disease,  even  if  the  patient 
be  brought  distinctly  under  the   physician's  eye, 
the  symptoms  of  it  are  often  so  slight  and  shad- 
owy, that  it  is  with  difficulty  the  disease  can  then 


ON    THE    UTILITY    OF    MEDICINE.  21 

be  recognized.  It  is  almost  impossible,  by  verbal 
instiniction,  to  prepare  any  man  to  detect  the 
disease  thus  early,  in  every  instance.  As  in  the 
cases  of  many  animals  and  plants,  with  which  you 
would  make  your  pupils  acquainted,  you  must 
take  them  to  the  objects,  in  order  to  make  them 
familiar  with  their  characteristics.  You  must 
show  them  the  specimens.  How  then  shall  the 
pupil,  or  the  young  physician  get  this  knowledge, 
by  which  to  recognize  typhoid  fever  at  its  very 
onset?  Let  him  avail  himself  of  the  opportuni- 
ties afforded  every  few  years,  in  New  England  at 
least,  when  this  disease  is  prevalent.  Then  he 
can  make  himself  familiar,  by  daily  observation, 
with  the  phenomena  of  the  disease  in  its  various 
stages  and  under  its  various  forms  and  shapes. 
In  fact,  during  a  season,  when  the  public  are 
under  an  alarm  from  the  epidemic,  patients  are 
oftener  induced  to  call  for  advice  on  the  first  ap- 
pearances of  disease  than  in  ordinary  seasons  ; 
and  in  two  years  of  such  an  epidemic,  if  not  in 
one,  the  medical  man  may,  with  diligence,  acquire 
such  a  knowledge  of  the  disease  as  will  subse- 
quently save  him  from  doubt,  at  least  with  rare 
exceptions.  But  he  must  first  study  it  with  the 
specimens  in  his  hands,  or  before  his  eyes. 


22  ON    THE    UTILITY    OF    MEDICINE. 

Let  it  be  granted  that  we  cannot  arrive  at  abso- 
lute certainty  on  the  first  day  of  typhoid  fever, 
yet,  at  least  where  it  is  epidemic,  we  may  be 
sufficiently  certain  for  practical  purposes ;  and, 
when  it  is  not  epidemic,  the  careful  observer  may 
be  sure  enough,  ordinarily.  It  is  true  that  an 
antimonial  emetic  has  a  powerful  influence  on  the 
system,  and  should  not  be  given  from  trifhng  con- 
siderations. Yet  when  one  is  as  well  assured,  as 
I  am,  of  the  great  benefits  which  this  remedy 
affords  in  the  very  commencement  of  this  disease, 
he  will  feel  justified  in  taking  some  risk.  Con- 
sider for  a  moment  the  amount  of  evil  to  be  ward- 
ed off.  In  typhoid  fever,  left  to  itself,  one  must 
ordinarily  pass  through  two  weeks  of  severe  sick- 
ness, two  to  three  more  weeks  of  confinement  to 
the  house ;  and  again,  from  two  to  five  more 
weeks,  before  he  is  truly  fit  to  return  to  his 
usual  occupations.  During  most  of  this  time 
there  are  the  evils  of  prostration  and  debihty  ; 
during  a  portion  of  it  those  of  pain,  —  often  great 
pain  and  distress ;  most  commonly  for  some  days 
there  is  delirium,  and  often  great  delirium,  and  to 
all  these  must  be  added  the  risk  of  life.  This  is 
a  great  risk.  I  cannot  put  the  proportion  of 
patients,  to  whom   the   disease  proves  fatal,  when 


ON    THE    UTILITY    OF    MEDICINE.  23 

not  arrested  by  treatment,  at  anything  less  than 
one  in  seven.  In  some  seasons  it  is  much  less 
fatal  than  this,  but  in  some  it  is  much  more  so. 
Viewing  the  antimonial  emetic,  administered  on 
tlie  first  day,  as  creating  almost  a  certainty  of  a 
speedy  and  safe  termination  of  the  disease,  1  think 
I  may  say  that  the  remedy  ought  to  be  employed 
in  every  case,  where  there  is  an  even  chance  that 
this  disease  has  begun  its  course.  For  myself,  in 
such  a  case,  I  should  not  hesitate.  But  why  do  I 
express  myself  thus  ?  I  have  been  placed  precisely 
under  these  circumstances,  and  I  did  avail  myself 
of  the  remedy  promptly.  This  was  in  1814,  when 
the  disease  was  very  prevalent  among  us.  I  was 
attacked  in  the  evening,  and  I  took  the  emetic 
about  midnight.  I  acknowledge  that  a  physician 
is  very  liable  to  err  in  regard  to  himself ;  I  should 
not  therefore  mention  this  case,  as  one  in  which 
it  was  certain  that  the  disease  had  taken  hold  of 
the  patient,  though  I  have  no  doubt  on  the  sub- 
ject. But  I  mention  it,  as  showing  the  strength 
of  my  conviction  of  the  advantages  of  the  remedy, 
and  to  show  that  I  employ  for  myself  what  I 
prescribe  for  others.  Let  it  not  be  forgotten  that, 
when  the  remedy  has  been  employed  at  the  very 
commencement  of  the  disease,  the  patient  should 


24  ON    THE    UTILITY    OF    MEDICINE. 

not  think  that  he  is  now  safe ;  he  should  be  re- 
garded as  a  sick  man  for  several  succeeding  days, 
even  though  he  should  appear  to  be  entirely  re- 
lieved of  all  disease.  If  he  will  not  do  this,  he 
will  be  very  likely  to  bring  on  the  disease  anew. 

I  have  not  stated  the  evils  of  this  disease  suffi- 
ciently. Of  those  who  recover  from  it,  not  a  few 
continue  unfit  for  the  common  duties  of  life  from 
three  to  six  months,  during  which  time  secondary 
affections  often  make  their  appearance.  And  it 
is  not  uncommon  to  meet  with  persons,  ten  and 
twenty  years  after  they  have  undergone  this  fever, 
who  refer  to  the  period  of  it  as  a  marked  era  in 
their  lives,  since  which  they  have  never  enjoyed 
perfect  health. 

The  greatest  benefit,  which  can  be  derived 
from  antimony,  is  that  to  which  I  have  here 
referred  ;  but  there  is  sufficient  evidence  that  it 
is  useful  in  typhoid  fever,  when  running  its 
course  ;  —  useful  in  mitigating  its  severity,  and 
perhaps  in  shortening  its  duration.  It  has  similar 
good  effects  in  some  other  affections,  when  em- 
ployed in  such  doses  as  do  not  ordinarily  prove 
operative.  It  has  had  a  reputation  for  producing 
favorable  effects  in  febrile  aff'ections,  and  in  certain 
inflammatory   diseases   for   several   ages.     It   can 


ON    THE    UTILITY    OF    MEDICINE.  25 

hardly  happen  that  it  should  have  retained  this 
reputation  among  physicians,  maintaining  very 
diverse  theories  on  pathological  and  therapeutical 
points,  if  it  had  not  in  some  measure  deserved  it. 
That  it  has  often  been  used,  when  there  was  not 
a  sufficient  occasion  for  it,  and  that  it  has  been 
employed  rashly  and  too  freely,  and  that  it  may 
have  been  productive  of  much  injury,  I  do  not 
doubt.  But  we  should  not  discard  it  on  these 
considerations ;  we  should  only  study,  with  in- 
creased care,  when  and  how  it  ought  to  be  pre- 
scribed. For  its  use  in  typhoid  fever,  after  the 
earliest  days,  I  will  refer  to  my  Report  on  that 
disease  already  mentioned.  I  might  refer,  no 
doubt,  to  better  and  higher  authorities ;  but  I 
mention  that  as  containing  the  results,  at  which 
my  mind  had  arrived.  I  think  this  medicine 
may  be  used  in  pneumonitis  and  inflammation  in 
the  internal  viscera  generally  ;  also  in  cases  of 
inflammation  of  the  mucous  membrane,  even  when 
this  is  not  sufficient  to  induce  strong  febrile  symp- 
toms. To  this  general  remark  an  exception  must 
be  made,  —  as  to  cases  of  inflammation  of  the 
mucous  membrane  of  the  stomach.  In  acute 
gastritis  there  is  scarcely  any  medicinal  article, 
which  will  not  offend  the  stomach ;  and  we  may 


26  ON    THE    UTILITY    OF    MEDICINE. 

say  nearly  as  much  of  even  the  mildest  articles 
of  diet.  The  same  may  be  fomid  true  in  acute 
inflammation  of  the  duodenum.  But  when  the 
inflammation  is  seated  in  the  lower  part  of  the 
small  intestines,  and  yet  more,  if  in  the  large  in- 
testines, I  think  that  antimony  may  be  employed, 
though  ipecacuanha  is  usually  preferable.  It  is, 
however,  especially  in  the  affections  of  the  mucous 
membrane  of  the  fauces,  of  the  larynx,  the  trachea 
and  the  bronchi,  that  I  am  in  the  habit  of  using 
antimonials  in  small  doses.  In  such  cases,  I  most 
frequently  add  opium  to  it.  In  affections  of  the 
windpipe  and  bronchi,  where  cough  and  expec- 
toration are  produced,  we  may  for  a  time  arrest 
the  cough  by  opiates  alone  ;  but  an  easy  expec- 
toration is  more  certain  to  follow  when  antimony 
is  added  to  the  opiate.  If  these  articles,  in  com- 
bination, be  administered  at  bed-time,  for  a  few 
successive  nights,  the  duration  of  the  disease  will 
generally  be  shortened.  To  be  successful,  we 
must  study  to  give  the  right  doses,  so  as  to  obtain 
the  greatest  good  with  the  least  inconvenience. 
A  reasonable  regard  to  diet  and  some  other  things 
is  necessary  to  secure  the  most  favorable  result. 
When  a  bronchitis  is  severe  at  the  beginning,  in 
a   person   who   can   endure  the  use  of  medicine 


ON    THE    UTILITY    OF    MEDICINE.  27 

without  much  trouble,  it  may  be  well  to  employ 
these  two  medicines  from  the  commencement  of 
the  disease.  In  such  a  case  and  wherever  the 
opiate  is  to  be  employed,  for  several  days  in  suc- 
cession, it  will  generally  be  found  necessary  to 
combine  with  these  two  articles  some  laxative 
medicine.  I  prefer,  however,  to  abstain  from  the 
use  of  opium  except  where  the  cough  is  protracted, 
or  where  the  patient  is  particularly  liable  to  pro- 
tracted coughs.  On  the  other  hand,  in  some 
instances,  where  the  bronchitis  appears  to  extend 
very  widely  through  the  lungs,  and  to  continue 
obstinately,  we  may  add  to  antimony  and  opium 
another  powerful  drug ;  —  powerful  for  hann 
when  employed  indiscreetly,  but  certainly  often 
very  powerful  for  good.  The  article  I  refer  to  is 
calomel.  For  an  ordinary  adult  we  may  add 
from  one  to  two  grains  of  calomel  to  each  of  the 
evening  doses  of  opium  and  antimony.  Such  a 
dose,  in  an  urgent  case,  may  be  taken  on  two  suc- 
cessive nights ;  but  ordinarily  it  should  not  be 
repeated  on  two  successive  nights.  The  antimony 
and  the  opium  may  be  continued  every  night, 
but  the  calomel  only  on  every  second,  or  every 
third  night.  It  is  very  seldom  proper  to  repeat 
the  calomel  more  than  three  times  after  the  first 


28  ON    THE    UTILITY    OF    MEDICINE. 

dose.  Indeed,  there  will  rarely  be  a  want  of  it, 
if  the  affection  is  bronchial  only.  It  very  seldom 
happens  that  we  need  to  employ  the  antimony, 
or  the  calomel,  for  young  children  in  cases  of 
bronchitis.  Yet  we  may  sometimes  do  it  with 
unequivocal  advantage,  even  for  them.  In  child- 
ren, as  early  as  the  fourth  year,  we  occasionally 
meet  with  protracted  bronchitis  causing  a  frequent 
and  very  annoying  cough  through  the  day  and 
much  more  in  the  night.  In  such  instances  I 
have  long  been  in  the  habit  of  employing  what  I 
have  called  my  "  puerile  pill,"  and  usually  with 
most  marked  success.  When  the  disease  has  been 
bronchitis  only,  not  combined  with  any  other 
disease,  the  pills,  I  have  used  under  this  name, 
have  contained  the  following  articles,  viz : 

Of  Tartarized  Antimony,  One  grain. 
Of  Opium,  .  .  .  One  grain. 
Of  Calomel,  .         .         .         Ten  grains. 

And  these  articles,  mixed  with  mucilage  of  Gum- 
Arabic,  have  been  divided  into  eight,  ten,  twelve 
or  fourteen  pills,  according  to  the  age  and  con- 
stitution of  the  patient.  I  have  given  one  of 
these  at  night,  and  most  commonly  a  second  on 
the  first  or  second  night  afterwards.     I  have  very 


ON    THE    UTILITY    OF    MEDICINE.  29 

rarely  used  any  more ;  for  though  the  disease 
has  not  been  entirely  removed,  yet  it  has  been  so 
decidedly  relieved  by  two  pills,  and  often  by  one, 
that  there  was  no  inducement  to  give  more.  I 
ought  to  say  that  the  first  dose  will  most  com- 
monly occasion  some  vomiting,  and  will  almost 
always  prove  cathartic,  sometimes  violently  so. 
But  the  evil  from  these  effects  is  usually  very 
transient,  and  this  is  fully  compensated  by  the 
marked  relief.  To  my  friends,  who  are  fearful  of 
the  use  of  strong  medicines,  I  will  say  that  a  few 
trials  in  cases  worthy  of  the  remedies,  would,  I 
believe,  remove  their  apprehensions.  To  those 
on  the  other  hand,  who  beheve  that  when  one 
dose  proves  to  be  very  useful,  a  second  and  a 
third  will  be  equally  so,  I  may  quote  here,  as  well 
as  on  many  other  occasions,  an  old  saying.  That 
two  and  two  do  not  always  make  four.  To  the  use 
of  antimony,  combined  with  other  medicines,  as 
above  described,  I  have  given  close  attention  for 
very  many  years,  during  my  pupilage,  and  ever 
since,  and  I  believe  that  my  commendations  of  the 
same  are  expressed  in  very  moderate  language. 
It  will  not  be  supposed  that  I  claim  to  myself  any 
originality  as  to  this  mode  of  using  antimony  and 
so  forth.     I  mean   only  to  add  my  testimony  to 


80  ON    THE    UTILITY    OF    MEDICINE. 

that  of  Others.  I  will  not  waste  time  in  discussing 
the  '"''modus  operandi  "  of  these  medicines.  On  all 
practical  questions,  if  others  will  agree  with  me 
as  to  the  results  produced  by  any  given  mode  of 
treatment,  I  am  satisfied  without  any  such  dis- 
cussion. 

A  few  remarks  will  be  added  on  Ipecacuanha,  a 
vegetable  article  similar  in  many  respects  to  anti- 
mony. Where  the  object  is  merely  to  unload  the 
stomach,  this  is  preferable  as  an  emetic  to  anti- 
mony. Though  more  offensive  to  the  taste,  it  is 
more  mild  in  its  operations.  For  young  children, 
especially,  and  for  all  tender  subjects,  it  is  the  most 
appropriate.  It  is  not  only  as  an  emetic  that  this 
medicine  is  a  substitute  for  antimony.  Though 
more  feeble  than  this  last,  it  supplies  its  place  in 
some  measure  as  an  an ti -febrile  medicine,  and  still 
more  in  combination  with  opium  in  bronchitis, 
dysentery,  and  some  similar  diseases.  I  will  not 
omit  to  say  it  produces  asthma  in  some  few  indi- 
viduals, even  from  handling  it.  To  such  persons 
it  should  not  be  given. 

The  Squill  is  another  article  sometimes  employed 
as  a  substitute  for  antimony,  or  more  commonly 
combined  with  it,  as  an  expectorant.  It  is  very 
valuable  for  this  purpose.     But  I  have  mentioned 


ON    THE    UTILITY    OF    MEDICINE.  ,        31 

the  squill  principally  to  comment  on  one  good 
property,  which  it  is  known  to  possess,  but  for 
which  it  is  not  sufficiently  valued  ;  I  mean  that  of 
a  diuretic.  From  my  own  experience  I  venture 
to  say  that  the  reason  why  it  is  not  sufficiently 
valued  in  this  respect,  is  that  it  is  not  usually  put 
to  the  test,  in  such  doses,  as  are  requisite  for  the 
purpose. 

It  is  well  known  that  dropsy  is  ordinarily  an 
effect  of  some  organic  disease,  such  as  is  seldom 
removed.  Nevertheless  the  dropsy  is  often  relieved 
temporarily,  —  for  wrecks  or  months,  or  occasionally 
for  years.  This  takes  place  spontaneously  some- 
times, but  much  more  often  by  the  use  of  medicine 
and  especially  of  diuretics.  In  such  cases  the 
squill  always  deserves  a  trial  before  resorting  to 
more  powerful  articles,  except  in  very  urgent  and 
distressing  cases.  It  succeeds  in  most  instances, 
and  though  it  may  occasion  some  nausea,  this  is 
seldom  severe,  or  long  continued.  I  think  that 
the  tincture  is  the  preparation  of  squills  the  most 
convenient  for  this  purpose,  because  its  dose  is 
readily  graduated  to  each  individual  case.  It 
should  be  given  in  such  quantity  as  the  stomach 
will  bear  without  nausea,  three  times  a  day.  It  is 
best  to  begin  with  twenty-five  drops  for  a  dose,  and 


32  ON    THE    UTILITY    OF    MEDICINE. 

to  increase  it  gradually.  Ordinarily  an  adult  can 
bear  thirty-five  drops,  but  some  bear  more  and 
some  less. 

Some  other  medicines  might  be  mentioned,  more 
or  less  similar  to  the  antimony,  &c.,  but  this  is  not 
necessary  to  my  purpose. 

As  the  third  among  Dr.  Holyoke's  four  great 
articles,  comes  Opium.  It  relieves  pain  ;  this  is  its 
great  power.  Where  immediate  relief  is  required, 
and  such  as  shall  not  be  transient  only,  it  certainly 
takes  the  first  place  among  anaesthetics.  There  is 
not  any  substitute  for  it  in  such  a  case.  Sul- 
phuric Ether  and  Chloroform  will  operate  more 
immediately ;  but  the  relief  they  afford  is  very 
transient,  unless  the  remedy  be  constantly  re- 
peated. There  are  other  vegetable  narcotics, 
besides  opium,  to  which  we  may  sometimes  be  glad 
to  resort,  where  the  effects  of  opium  are  particular- 
ly annoying.  Conium  and  Hyoscyamus  are  very 
feeble  compared  with  opium,  yet  we  succeed  with 
them  in  some  instances.  It  is  necessary  to  begin 
with  the  use  of  these  in  moderate  doses,  although 
these  medicines  rarely  produce  decided  effects 
until  larij-e  doses  are  administered.  Stramonium  is 
much  more  powerful,  and  hence  must  be  used  with 
great  caution.     It  may  produce  more  or  less  of 


ON    THE    UTILITY    OF    MEDICINE.  33 

blindness,  even  in  moderate  doses  ;  and  life  itself  is 
endangered  by  it  in  large  ones.  Aconite  is  so  haz- 
ardous, when  used  internally,  that  it  should  never 
be  resorted  to,  except  on  very  extraordinary 
occasions.  Employed  externally^  in  a  saturated 
tincture,  it  is  not  hazardous,  and  sometimes  gives 
relief  to  severe  pain.  I  should  be  unwilling  to 
banish  either  of  these  articles ;  and  without  opium, 
I  should  hardly  be  willing  to  practice  medicine. 
At  the  same  time,  I  resort  to  this  invaluable  drug 
with  reluctance,  and  especially  to  a  continued  use 
of  it,  even  for  a  few  successive  days,  and  with  still 
greater  reluctance  for  longer  periods.  In  regard 
to  this  drug  especially,  I  may  say  that  it  should 
never  be  prescribed  without  bearing  in  mind  the 
evils  it  may  produce.  Some  persons  can  take  it 
without  any,  or  with  only  very  little  inconvenience ; 
but  there  are  a  few  in  whom  its  effects  are  very 
distressing.  There  are  persons  in  whom  they  are 
so  much  so,  as  to  forbid  the  use  of  it  entirely.  It 
takes  away  the  appetite,  and  impairs,  —  often 
destroys,  —  the  power  of  digesting  food.  It  con- 
stipates the  bowels,  and  checks  all  the  secretions 
and  excretions,  except  cutaneous  perspiration. 
And,  very  frequently,  it  prevents  perfect  sleep. 
I  say  this  notwithstanding  it  is  regarded  as  the 


34  ON    THE    UTILITY    OF    MEDICINE. 

first  of  soporifics.  After  long  continued  distress, 
or  pain,  it  sometimes  produces  calm  and  refi*esh- 
ing  sleep.  When  sleep  has  been  prevented  by 
a  cough,  it  may  often  be  obtained  by  an  opiate 
in  a  very  moderate  dose.  But,  in  a  large  pro- 
portion of  cases,  the  sleep  produced  by  opium  is 
imperfect.  Especially  the  mind  gets  no  rest.  It 
is  disturbed  by  dreams,  and  often  by  such,  as 
are  very  distressing ;  and  it  is  not  productive 
of  any  refreshment.  Such  are  the  effects  on 
many  subjects.  Some  persons,  more  fortunate, 
are  always  soothed  and  tranquilized  by  opium, 
and  think  of  it  only  as  a  comforter.  For  such 
persons,  if  the  occasion  require,  we  may  be  more 
willing  to  protract  the  use  of  it.  But  when  long 
continued,  I  believe  that  it  always  undermines  the 
constitution. 

The  last  and  fourth  of  the  articles  mentioned 
by  my  old  master,  is  Cinchona,  —  the  bark  of  the 
cinchona,  —  which  in  my  youth  was  familiarly 
called  The  Bark.  It  is  regarded  as  a  specific 
remedy  for  the  Fever  and  Ague.  It  used  to  be 
thought  that,  if  the  physician  would  *'  put  down 
the  Bark  "  in  full  doses,  it  would  certainly  arrest 
an  intermittent  fever  without  any  other  medicine. 
But  I  believe   that  those  who  have  tried  it  much 


ON    THE    UTILITY    OF    MEDICINE.  35 

in  malarious  districts,  have  found  it  best  to  pre- 
pare the  patient,  and  especially  to  attend  to  the 
stomach,  into  which  it  was  to  be  introduced,  before 
administering  this  potent  drug.  As  it  was  often 
necessary  to  administer  this  bark  in  large  quanti- 
ties, the  task  of  taking  it  was  a  severe  one.  At  the 
present  day  we  employ  the  Alkaloid  derived  from 
the  cinchona,  known  as  Quinia,  or  Quinine,  of 
which  the  doses  are  so  small  in  bulk,  as  to  remove 
the  terrors  of  it.  This  medicine  is  employed  not 
only  in  regular  intermittent  fever,  but  also  in  the 
irregular  intermittents  and  remittents,  such  as  are 
often  epidemic  and  pestilential  in  hot  climates. 

There  are  other  diseases,  which  have  intermis- 
sions more  or  less  regular,  in  which  the  cinchona, 
or  its  alkaloid,  may  be  employed  with  great  ad- 
vantage. The  most  distinctly  marked  of  these 
is  the  intermittent  Hemicrania.  It  has  appear- 
ed to  me,  as  I  have  stated  elsewhere,  that  the 
effect  of  this  medicine  is  to  take  awa}"  the  dispo- 
sition to,  or  the  susceptibility  of,  certain  diseases, 
some  of  them  not  intermittent.  When  exhibited 
in  full  doses,  it  will  often  put  a  stop  to  those 
painful  affections,  which  occur  independently  of 
inflammation  and  of  any  organic  disease,  and 
appear  to  be  fimctional  disorders  in  the  nervous 


86  ON    THE    UTILITY    OF    MEDICINE. 

system.  In  these  cases  it  is  not  necessary  to  the 
beneficial  use  of  the  medicine,  that  the  pain 
should  have  any  regular  periods,  such  as  we  see 
in  the  intermittent  hemicrania. 

I  may  repeat  here  what  I  have  said  in  the  16th 
Letter  of  this  series,  320th  page.  In  that  letter 
I  mentioned  its  good  influence  in  arresting  certain 
cutaneous  diseases,  of  which  the  furunculi  (boils) 
ftirnish  the  most  remarkable  instance.  In  all  these 
cases,  where  the  intention  is  to  overcome  the  sus- 
ceptibility to  a  disease,  I  consider  it  requisite  to 
begin  the  use  of  the  medicine  in  large  doses.  A 
little  of  it  will  not  do  a  little  good ;  it  even  does 
harm.  Beginning  with  small  doses,  and  gradually 
increasing  them,  it  seems  to  me  that  the  system 
becomes  accustomed  to  the  medicine,  so  that  even 
large  doses  afterwards  fail  to  do  good.  The 
evils  produced  by  this  medicine  are  —  a  sense  of 
stricture  in  the  head,  noises  in  the  ears,  not 
usually  very  distinct,  and  a  slight  deafness,  or  a 
diminution  in  the  power  of  hearing.  To  avoid 
these  evils,  when  they  are  great,  and  sometimes 
because  the  patient  is  under  some  other  disease, 
which  is  thought  to  forbid  the  use  of  the  quinia, 
we  substitute  arsenic.  The  name  often  excites 
some  terror.     It  may  be  used  so  as  to  destroy  life  ; 


ON    THE    UTILITY    OF    MEDICINE.  87 

and  so  may  opium,  and  so  may  a  lancet,  or  a 
scalpel,  if  placed  in  improper  hands.  But  as 
arsenic  has  a  bad  character  with  many,  I  feel 
bound  to  testify  that  it  as  mild  and  gentle  in  its 
effects  on  the  human  body,  as  almost  any  efficient 
medicine  ever  employed  by  us.  If  the  physician 
watch  its  effects  from  day  to  day,  his  patient  will 
seldom  experience  as  much  trouble  from  it,  as  is 
often  brought  about  by  quinia.  General  experi- 
ence bears  witness  to  the  good  effects  of  arsenic 
in  intermittent  fevers,  and  in  various  chronic  cu- 
taneous diseases.  I  am  aware,  that  in  these  last, 
the  good  effects  of  this  medicine  are  attributed  to 
some  salutary  operation  upon  the  blood.  It  is  so 
regarded,  when,  in  the  language  of  the  day,  the 
disease  is  called  a  blood-disease.  It  may  be  that 
this  is  correct.  I  do  not  profess  to  have  pene- 
trated with  any  success,  the  arcana  of  blood  dis- 
eases. But,  to  my  mind,  the  explanation  above 
suggested,  in  regard  to  the  good  effects  of  the 
cinchona  and  arsenic  in  intermittent  diseases,  and 
on  those  which  are  frequently  recurring  in  the 
same  subject,  though  not  at  regular  periods,  is 
much  the  most  satisfactory.  I  know  that  we  may 
be  told  that  both  these  remedies  are  tonics ;  but  I 
have  not  found  them  acting  as  such  in  these  cases. 


38  ON    THE    UTILITY    OF    MEDICINE. 

In  regard  to  quinia  especially,  I  can  say,  that, 
when  exhibited  in  full  doses,  it  does  not  manifest 
any  effects,  showing  that  it  acts  as  a  tonic.  If 
I  wish  in  a  debihtated  subject  to  increase  the 
appetite,  or  to  fortify  the  stomach  in  any  way,  I 
may  give  the  sulphate  of  quinia,  in  doses  of  one 
or  two  grains,  twice  or  thrice  in  a  day,  and  often 
with  good  effect.  I  agree  that  its  effects  are  tonic 
in  those  instances.  But  when  I  give  from  fifteen 
to  twenty-five  grains  in  a  day,  I  usually  find  the 
appetite  is  diminished,  and  that  the  power  to 
digest  the  food  is  diminished  also.  Yet  it  is  in 
the  large  doses  that  it  arrests  an  intermittent 
fever,  and  prevents  the  recurrence  of  neuralgia. 
Therefore  it  is  that  1  say,  it  is  not  by  its  tonic 
effects  it  stops  the  intermittent  fever.  If  we  at- 
tribute to  this  medicine,  when  given  in  large 
doses,  the  power  to  arrest  the  disposition  to  cer- 
tain diseases,  we  can  explain  its  effects  in  diseases 
apparently  quite  diverse  from  each  other.  Similar 
remarks  may  be  justly  applied  to  arsenic. 

Iron  is  a  medicine  similar  in  some  respects  to 
cinchona,  and  it  is  among  the  medicines  which  no 
one  would  be  willing  to  dispense  with.  In  dis- 
eases, in  which  there  is  a  deficiency  of  the  red 
globules  of  the  blood,    benefit  may   often   be   ob- 


ON    THE    UTILITY    OF    MEDICINE.  39 

tained  from  the  use  of  iron  internally.  For  this 
purpose  it  need  not  be  given  in  large  doses. 
Whether  acting  as  a  nutriment,  or  as  a  tonic,  in 
some  way,  certainly,  it  often  operates  to  restore 
the  strength  of  debilitated  subjects,  especially 
where  there  is  not  any  organic  disease  present. 
There  are  many  preparations  of  it  in  use,  some  of 
which  are  effectual  in  small  doses,  and  cannot  be 
borne  in  large  ones ;  while  others,  as  the  carbon- 
ate and  phosphate,  may  be  given  in  very  large 
doses.  It  does  not  appear  to  be  more  useful  as  a 
tonic,  when  employed  in  large  doses,  nor  does  it 
always  produce  any  increase  of  tone.  But  when 
employed  in  large  doses,  it  does  appear  sometimes 
to  have  an  effect  on  the  nervous  system.  From 
my  own  experience,  however,  I  judge  that  it  can- 
not be  relied  on,  so  much  as  quinia,  for  the  relief 
of  chronic  pains,  or  of  neuralgia. 

There  are  many  sub-tonics,  as  they  are  some- 
times called,  which  might  be  brought  into  notice 
in  connection  with  these  remarks  on  cinchona, 
and  which  I  think  no  experienced  physician 
would  be  willing  to  dispense  with.  Among  the 
principal  of  these  I  place  Bismuth,  Cascarilla,  and 
Quassia.  There  is  one  other  article,  in  much  use 
at  the  present  day  —  I  mean   Cod  Liver  Oil  — 


40  ON    THE    UTILITY    OF    MEDICINE. 

wliich  deserves  to  be  noticed  as  a  restorative,  if 
not  a  tonic.  It  is  certain,  that  persons,  who  are 
much  emaciated  and  much  debihtated,  often  un- 
dergo a  great  change  while  using  this  medicine. 
Its  effect  in  giving  to  the  patient  a  coating  of  fat 
might  lead  one  to  ask,  if  it  does  not  operate  as  a 
nutriment ;  but  I  believe  it  has  been  found  that 
the  addition  to  the  weight  of  the  body,  when  it 
has  been  used  three  or  four  weeks,  is  actually 
greater  than  the  weight  of  the  oil  which  has  been 
taken.  While  the  patient  becomes  more  corpu- 
lent, from  the  use  of  this  oil,  he  is  generally 
stronger  after  it.  Thus  we  may  be  authorized  to 
suppose,  that,  if  it  acts  as  a  nutriment,  it  also  acts 
as  a  tonic.  We  still  wait  for  further  experience 
to  decide  us  as  to  its  true  influence. 

I  have  thus  been  treating  of  various  medicines, 
more  or  less  similar  to  the  four  great  articles 
pointed  out  by  Dr.  Holyoke.  I  have  mentioned 
those  only,  which  have  occurred  to  me  as  best 
established  in  their  character  without  professing 
to  have  looked  carefully  through  the  list  of  the 
Materia  Medica.  I  will  now  bring  into  view 
some  other  drugs,  or  medicines  not  allied  to  those 
four  articles.  And  first,  of  the  tribe  called 
Cathartics.     Of  these  we  have  a  great   variety  ; 


ON    THE    UTILITY    OF    MEDICINE.  41 

the  harsh  and  powerfiil,  the  light  and  gentle. 
Some  of  these  we  employ  when  we  w.nt  only  to 
empty  the  bowels  of  their  ordinary  contents : 
some  can  do  more ;  tliey  promote  the  watery 
secretions.  These  are  called  drastic  cathartics. 
There  is  not  any  tribe,  or  class  of  medicines  so 
much  used  as  this.  It  would  seem  that  we  could 
hardly  live  without  the  use  of  cathartics.  They 
are  necessary.  But  the  abuses  in  their  use  are 
enormous.  For  the  great  mass  of  mankind,  who 
labor  in  the  open  air,  and  who  are  provided  with 
food  tolerably  well  adapted  to  the  powers  of  the 
digestive  organs,  these  medicines,  Hke  other  medi- 
cines, are  very  rarely  needed.  But  in  civilized 
communities,  in  cities  most  especially,  there  must 
always  be  a  large  proportion  of  men  and  women 
who  pass  most  of  their  time,  in  houses  or  offices, 
and  without  sufficient  exercise,  or  without  that 
which  is  of  the  best  kind.  Among  these  persons 
cathartics  are  much  used,  —  too  much.  Yet,  un- 
der the  actual  circumstances  of  mankind,  they 
cannot  be  entirely  dispensed  with  by  such  persons. 
The  rich  and  luxurious  are  very  prone  to  live  in- 
active lives ;  or,  if  they  go  abroad,  their  exercise 
is  often  passive  only.  Preaching  to  such  persons 
is  sometimes  very  useful :  but,  too  often,  I  have 
4 


42  ON    THE    UTILITY    OF    MEDICINE. 

found  it  useless,  as  much  better  preaching  often  is. 
1  believe  that  some  patients  say  to  themselves,  if 
not  to  us,  what  are  doctors  good  for,  if  they  can- 
not  prescribe  some  remedies  in  these  cases,  less 
troublesome    than    diet    and    exercise  ?        Alas  I 
neither  Emperors,  nor   Empresses  can    command 
any  other  remedy,  that  is  consistent  with  health. 
There  is  a  large  proportion  of  the  employments, 
by  which  the  inhabitants  of  cities,  and  of  manu- 
facturing districts  gain  their  livelihood,  which  are 
necessarily  sedentary  and  within  doors.     Among 
all  the  persons  thus  described,  we  find  more  or  less 
failure  in  the   functions  of  the  digestive   organs. 
This  failure  is  increased  when  the  food  best  adapt- 
ed to  such  persons  cannot  be  obtained.     Persons 
thus  circumstanced  are  compelled  to  seek  aid  from 
the  physician.     It  is  first  of  all  proper  for  him  to 
make  them  acquainted  with  the  causes  of  their  ill 
health.     He  should  point  out  to  them  the  necessity 
of  exercise  in  the  open  air,  and  the  changes  in 
diet,  wliich,  in  each  case,  respectively,  are  neces- 
sary for  their  relief     But,  after  his  best  efibrts,  he 
will  find  many,  who  either  will  not,  or  cannot  obey 
the  hygienic  rules,  which  he  points  out  to  them. 
Thus,  at  last,  he  is  driven  every  day  to  allow,  or 
direct  some  of  them  to  use  medicine  for  relief.     It 


ON    THE    UTILITY    OF    MEDICINE.  43 

is  an  evil  to  which  the  feeble,  especially  if  poor, 
must  submit.  Shall  we  reproach  a  widow,  who 
supports  herself  and  two  children  by  her  needle, 
and  in  doing  it  often  sits  up  half  the  night,  — 
shall  we  reproach  her,  because  she  does  not  follow 
our  prescriptions  as  to  diet  and  exercise? 

In  addition  to  the  call  for  cathartics  for  the 
causes  above  stated,  there  is  very  frequently  a 
propriety  in  employing  the  same  for  temporary 
and  transient  disorders.  In  the  commencement 
of  acute  febrile  diseases,  even  although  they  be  self- 
limited,  so  that  we  cannot  hope  to  remove  them 
by  any  treatment,  cathartics  may  usually  be  ad- 
ministered with  more  or  less  benefit ;  at  least,  so  I 
think.  Some  of  the  wisest  among  my  brethren 
think  otherwise.  I  believe  that  experience  jus- 
tifies my  opinion.  It  seems  to  me  that  it  is  easy 
to  explain  in  what  way  this  depletion,  under  such 
circumstances,  is  ordinarily,  though  not  always, 
beneficial.  The  intestines  are  almost  never  empty. 
On  the  other  hand,  they  ordinarily  contain,  in 
health,  a  certain  amount  of  fecal  matter,  and  that 
sufficient  to  make  up  several  such  discharges,  as  are 
usually  produced  by  a  cathartic.  Such  a  quantity 
is  commonly  found  on  hand,  when  a  man  is  attacked 
with  an  acute  disease.     If  he  had  remained  well, 


44  ON    THE    UTILITY    OF    MEDICINE. 

a  due  portion  of  it  would  probably  have  been 
discharged  on  the  day  of  his  attack,  or  on  the 
following  day.  From  the  influence  of  the  acute 
disease  the  intestines  become  incapacitated,  in  some 
measure,  for  performing  their  ftmctions  with  their 
usual  vigor.  Meanwhile,  by  the  undue  retention 
of  their  contents,  the  whole  system  is  embarrassed. 
Left  to  themselves,  the  intestines  may  labor  on, 
for  several  successive  days,  before  they  can  be 
fully  relieved,  and  from  this  cause  the  general 
disease  is  augmented.  Precisely  this  state  of 
things,  I  have  very  often  witnessed.  If,  under 
the  use  of  some  moderate  laxative,  the  desired 
relief  can  be  hastened,  the  patient  may  go  through 
his  disease  with  less  discomfort,  and  ultimately 
with  less  reduction  of  strength.  Such,  I  believe 
to  be  the  true  explanation  of  the  good  effects, 
which  are  usually  experienced  from  cathartics  in 
the  commencement  of  acute  diseases.  I  believe 
that  the  same  benefits  ensue,  upon  the  same  treat- 
ment, in  surgical  cases  where  patients  are  suddenly 
brouiiht  to  the  bed,  and  become  affected  with 
symptomatic  fever.  On  the  other  hand,  if  the 
patient,  to  whom  such  a  prescription  has  been 
found  distinctly  useful,  is  treated  with  a  repetition 
of  the  dose  every  day  or  two,  great  evil  ensues. 


ON    THE    UTILITY    OF    MEDICINE.  45 

This  is  one  of  the  abuses  of  medicine,  which  is 
rare  among  us  at  the  present  time,  but  of  which 
however  we  sometimes  continue  to  see  instances. 

I  might  go  on  to  show  other  occasions,  on 
which  cathartic  medicines  may  be  properly  or- 
dered, but  I  believe  it  will  be  enoucjh  to  refer  to 
my  letter  on  Constipation,  and  to  passages  in 
other  letters  of  the  preceding  series  for  statements 
on  these  points.  My  main  object  at  present  is  to 
bring  into  view  the  medicinal  drugs  which  I 
should  not  be  willing  to  discard  ;  yet,  while  doing 
this,  I  endeavor  to  intersperse  such  practical  re- 
marks as  I  think  may  be  found  useful. 

I  have  not  forgotten  that  Dr.  Holmes  advises 
us  to  think  more  of  the  expectant  treatment  of 
diseases,  then  we  usually  do.     I  go  with  him  to 

certain  extent,  perhaps  as  far  as  he  does.  There 
are  some  acute  diseases,  in  which  it  is  best  to  do 
so  from  the  first ;  — ^  and  it  more  frequently  be- 
comes proper,  when  the  early  days  have  been 
passed  over  before  medical  aid  is  called  for.  In 
many  chronic  diseases,  from  which  recovery  can- 
not be  expected,  much  may  be  done  to  render 
the  patient  more  comfortable.  But  in  such  it  is 
oftener  by  hygienic  measures,  than  by  drugs,  that 
we  do  the  most  good. 


46  ON    THE    UTILITY    OF    MEDICINE. 

There  have  been  many  abuses  of  medicine 
among  the  regular  practitioners  beyond  doubt. 
But  I  am  wilUno;  to  believe  that  this  is  much 
less  common  now,  than  in  some  past  times. 
If  our  profession  has  famished  many  heroic 
practitioners,  many  who  have  distrusted  nature 
altogether,  or  who  are  not  willing  to  wait  for 
her  tardy  steps,  it  has  also  no  doubt  in  all  ages 
famished  those,  who  have  not  published  their 
opinions,  but  who  have  calmly  and  quietly  watched 
the  course  of  diseases  under  their  care,  and  by 
gentle  means,  and  only  when  the  powers  of  nature 
seemed  much  embarrassed,  have  ventured  to  em- 
ploy any  potent  drugs.  There  is  perhaps  always 
a  tendency  among  physicians  to  pursue  this  course, 
as  they  advance  to  old  age.  Unquestionably  this 
is  often  the  right  course.  But,  far  advanced  as 
I  am  in  age,  I  am  not  yet  ready  to  adopt  this 
course  entirely.  I  am  fully  convinced  that,  in  the 
early  stage  of  diseases,  powerful  remedies  may  be 
employed  with  great  benefit.  Indeed,  it  is  scarcely 
necessary  for  me  to  say  this,  since  in  this  letter, 
as  well  as  in  others  which  have  preceded  it,  I 
have  named  many  diseases,  in  which  I  have 
advised  very  active  treatment  under  these  con- 
ditions. 


ON    THE    UTILITY    OF    MEDICINE.  47 

There  is  a  tribe  of  diseases  which  must  be  per- 
mitted to  have  their  own  way,  if  I  may  use  the 
expression.  For  instance,  when  the  measles,  or 
the  small-pox  has  begun  its  course,  it  cannot,  if 
life  continue  in  the  subject  of  it,  be  prevented 
from  going  through  its  regular  steps.  But  even 
in  these  cases,  w^hen  fi'om  any  cause  the  disease 
is  peculiarly  violent,  aggravated  by  untoward 
circumstances,  we  may  often  do  something  to 
diminish  these  accidental  evils.  Indeed,  more 
may  be  said,  if  Sydenham  and  many  of  his  follow- 
ers have  not  misled  us ;  merely  by  the  free  ex- 
posure of  a  patient  under  the  small-pox  to  cool 
fresh  air,  we  may  always  lessen  both  the  suffering 
and  the  risk  attending  that  disease.  If  it  is  said 
that  no  drug  is  used  in  this  case,  I  reply  that  a 
powerful  remedy  is  used,  and  one  which  was  at 
first  thought  to  be  attended  with  great  danger. 
Diseases  like  these,  which,  when  they  have  be- 
gun, must  pass  through  certain  stages,  and  which 
sometimes  terminate  fatally,  have,  as  you  know, 
been  denominated  by  Dr.  Bigelow,  self -limited. 
Although  the  view,  which  he  took  of  this  subject, 
was  not  altogether  new,  yet  he  brought  it  much 
more  clearly  into  the  light  than  had  been  done 
previously,  and  pointed   out  the  uselessness  and 


48  ON    THE    UTILITY    OF    MEDICINE. 

the  frequent  -evils  of  an  attempt  to  arrest  dis- 
eases of  this  tribe.  I  think  no  reasonable  man 
will  now  hesitate  to  admit  the  justice  of  his 
opinions  and  the  importance  of  regarding  them 
in  practice. 

There  is  however  a  point  yet  to  be  settled. 
What  are  the  diseases  which  are  included  in  this 
natural  tribe  ?  Dr.  Bigelow  has  mentioned  many, 
without  professing  to  exhaust  the  subject.  I  agree 
as  to  most  of  those  enumerated  by  him,  but  not 
as  to  all  of  them.  I  have  some  doubts  as  to 
erysipelas.  I  have  much  more  as  to  typhoid 
fever,  as  I  have  stated  in  my  seventeenth  letter. 
Generally,  it  may  be  time,  as  to  some  diseases, 
tliat  they  are  self-limited,  when  they  have  ar- 
rived at  a  certain  period  ;  when,  for  instance, 
they  have  passed  the  second  or  third  day, 
but  not  before.  Dr.  Bigelow  has  also  placed 
epilepsy  among  the  self-limited  diseases.  How 
far  this  is  correct,  is  to  be  tested  by  experience. 
I  am  fully  convinced  that  all  active  interference, 
during  the  fit,  is  useless  and  may  be  injurious. 
But,  viewing  the  disease  as  a  whole,  regarding 
the  patient  as  having  at  all  times  a  liability  to 
the  epileptic  paroxysm,  the  question  is,  can  this 
liability  be  removed  ?     My  reply  to  this  has  been 


ON    THE    UTILITY    OF    MEDICINE. 


49 


given  in  the  second  of  these  letters.  This  reply 
is  substantially  as  follows  :  —  First,  so  far  as  I 
know/  there  is  not  any  medicine^  which  can  be 
relied  on  to  overcome  this  liability.  So  dreadful 
is  the  disease,  so  hard  to  be  endured  both  by  the 
patient  and  his  friends,  that  I  suppose  men  will 
never  cease  to  try  medicinal  articles  for  this  pur- 
pose. I  would  warn  them  to  be  careful  in  their 
experiments ;  but  I  would  certainly  hope  and  pray 
that  their  eiForts  may  ultimately  be  crowned  with 
success.  Secondly,  there  is  a  large  proportion  of 
cases,  in  which  I  suppose  no  mode  of  treatment, 
now  known,  will  effect  the  desired  object.  I 
cannot  find  out  any  marks,  by  which  these  in- 
tractable cases  may  be  distinguished  v*'ith  cer- 
tainty. I  will  say,  however,  that  the  older  the 
patient,  and  the  longer-  time  the  disease  has  ex- 
isted, the  less  will  be  the  chance  of  recovery. 
Thirdly,  I  am  happy  to  say  that  there  are  some 
epileptics,  though  not  the  larger  portion  of  these 
unfortunate  invalids,  who  may  be  relieved  per- 
manently by  care  in  diet  and  regimen  ;  particu- 
larly by  abstinence  from  animal  food.  I  am  happy 
that  it  is  not  the  use  of  a  powerful  di-ug,  which 
I  urge  upon  my  brethren  for  this  dreadful  disease ; 
but  I  will  say  that  for  a  disease  so  distressing  to 
5 


50  ON    THE    UTILITY    OF    MEDICINE. 

the  patient  and  to  his  friends,  a  drug  could  scarcely 
be  named,  which  I  would  not  administer,  if  it 
could  be  done  with  a  reasonable  chance  of  success. 
It  is  perfectly  consistent  with  this  to  add  that  the 
random  employment  of  strong  medicines,  dreadful 
as  the  disease  is,  is  entirely  unjustifiable. 

I  have  stated  my  belief  that  typhoid  fever  may 
sometimes  be  arrested  at  once  within  the  first 
three  days  ;  or,  if  not  arrested,  that  it  may  be 
shortened  by  treatment  at  that  early  period.  After 
that,  it  may  be  regarded  as  a  self-limited  disease ; 
and,  for  the  most  part,  the  physician  is  not  called 
to  the  cure  of  the  disease  until  after  that  period. 
Now  I  am  inclined  to  say  the  same  things  in 
regard  to  pleurisy,  pneumony,  and  the  similar 
affections.  At  the  very  commencement  of  these 
diseases  I  believe  that  they  may  be  diminished  in 
violence,  and  in  duration,  sometimes  perhaps  may 
be  arrested,  jugulated,  by  blood-letting,  aided  by 
appropriate  antiphlogistic  remedies. 

The  value  of  blood-letting  in  the  treatment  of 
diseases,  has  been  variously  estimated  in  different 
ao-es  and  in  different  places.  Within  the  hfe- 
time  of  some  of  our  brethren  now  living,  this 
practice  was  carried  to  a  great  excess,  by  a  very 
distinguished  medical  teacher  in  our  own  country. 


ON    THE    UTILITY    OF    MEDICINE.  [)1 

I  refer  to  Dr.  Rush,  whose  influence  during  the 
latter  part  of  the  last  century,  and  the  earlier 
part  of  this,  was  greater  and  more  extensive  than 
that  of  any  other  physician  in  the  United  States. 
It  was  not  in  New  England  that  his  influence  Avas 
thus  great ;  but  it  was,  I  believe,  in  every  State 
out  of  New  England.  Yet,  here,  blood-letting  was 
resorted  to  in  pleurisy  and  lung  fever,  if  not  in 
other  inflammatory  diseases.  It  has  also  been 
used  in  this  vicinity  in  various  affections  of  preo*- 
nant  women,  and  with  great  benefit.  My  old 
master  told  me  during  my  pupilage,  that  women 
bear  bleeding  during  pregnancy  much  better  than 
men,  or  than  women  in  other  circumstances.  The 
justice  of  this  statement  was  fully  confirmed  by 
my  own  experience  in  the  early  part  of  my  life  ; 
for  I  gave  up  all  obstetric  practice  when  I  had 
been  in  business  eighteen  years. 

In  this  city,  during  the  life  of  Dr.  Rush,  there 
was  one  practitioner,  regarded  by  many  as  the 
most  scientific  man  among  us,  who  abstained  from 
blood-letting  entirely,  or  nearly  so.  This  was 
Dr.  Samuel  Danforth,  a  man  with  a  strong  mind 
and  a  strong  will,  but  wedded  to  a  theory.  It  is 
singular  that,  while  there  was  a  great  similarity  in 
the  doctrine  of  these  two  gentlemen,  there  was 


52  ON    THE    UTILITY    OF    MEDICINE. 

none  in  their  practice.  Like  the  old  methodics^ 
and  the  late  John  Brown  of  Edinburgh,  both  of 
them  regarded  disease  as  differing  from  health  in 
more  or  less  of  something.  If  health  was  thought 
to  be  maintained  by  a  certain  amount  of  tension 
in  the  living  fibres  of  the  body,  then  it  was 
thouo-ht  that  disease  consisted  in  more  or  less 
tension,  more  or  less  excitement,  than  appertained 
to  health.  This  description  is  sufficient  in  a  gen- 
eral view  of  the  systems  of  these  various  medical 
philosophers.  Some  of  them.  Rush  especially, 
regarded  disease  as  a  unit.  But  between  Rush 
and  Danforth  there  was  this  difference.  Rush 
believed,  that,  in  almost  all  instances,  disease  con- 
sisted in  too  much  excitement.  Danforth,  on  the 
contrary,  maintained  that  it  consisted  almost  al- 
ways in  too  little.  Hence,  Rush  almost  con- 
stantly prescribed  blood-letting,  that  he  might 
diminish  the  amount  of  the  most  general  stimu- 
lant, one  which  pervades,  or  at  least  has  an  influ- 
ence on,  every  fibre  of  the  body.  In  a  very  large 
proportion  of  febrile  diseases  there  is  experienced 
after  bleeding  some  relief,  for  the  moment  at  least, 
as  to  pain  and  distress.  There  may  be,  at  the 
same  time,  a  feeling  of  exhaustion,  and  not  un- 
commonly   syncope    ensues.      But    then    this    is 


ON    THE    UTILITY    OF    MEDICINE.  53 

treated  as  a  temporary  Inconvenience,  making 
ultimate  relief  more  certain.  Hence  the  sick 
were  led  to  submit  to  this  treatment,  and  to  re- 
gard the  evacuation  as  useful.  The  other  gentle- 
man. Dr.  Danforth,  looking  at  debility  as  the 
great  source  of  disease,  administered  diffusible 
stimulants,  with  an  idea  that,  if  they  do  not  give 
permanent  strength,  they  bring  on  the  normal 
actions,  by  which  the  strength  may  be  renovated. 
He  also  looked  ultimately  to  nutrition  as  furnish- 
ing the  substantial  means  of  restoration.  With 
this  view,  he  took  care  to  relieve  the  alimentary 
canal  from  any  undue  burden,  and  from  any 
offensive  materials,  which  he  supposed  it  might 
contain.  When  thus  prepared,  he  believed  that 
the  patient  might  be  brought  back  to  a  normal 
condition,  sooner  or  later,  by  furnishing  him  with 
proper  nutriment,  and  adding  to  it  direct  stimu- 
lants, by  which  all  the  organs,  but  the  digestive 
organs  especially,  might  be  driven  to  the  perfonn- 
ance  of  their  proper  functions.  At  the  same  time, 
he  paid  great  attention  to  some  other  hygienic 
laws,  thereby  favoring  the  influence  of  good  diet. 
In  a  large  proportion  of  chronic  diseases,  the 
patient  derived,  at  least,  temporary  comfort  from 
this  treatment ;    and   when    pursued   with  judg- 


54  ON    THE    UTILITY    OF    MEDICINE. 

meiit,  and  where  no  organic  disease  embarrassed 
the  case,  he  often  obtained  from  it  permanent  reUef. 
In  acute  diseases  rehef  followed,  in  a  greater  or 
less  degree,  from  the  early  evacuations  of  the 
alimentary  canal,  which  he  thought  a  necessary 
preparation  for  his  other  treatment.  But  the 
plan  of  supplying  nutriment,  and  of  using  diffu- 
sible stimulants  in  acute  diseases,  sometimes  occa- 
sioned much  trouble  and  distress.  However,  Dr. 
Danforth  was  ordinarily  too  sagacious  to  press 
this  treatment  very  strongly,  when  the  patient's 
feelings  forbade ;  then  he  waited  and  watched  his 
chance.     In  this  way  he  often  succeeded. 

While  these  two  gentlemen  pursued  courses  so 
opposite  to  each  other,  the  majority  of  medical 
men  in  this  vicinity,  less  wedded  to  system, 
adapted  their  treatment  more  carefully  to  the 
actual  condition  of  their  patients.  This,  at  least, 
was  their  plan;  they  meant  to  do  so.  It  must 
however  be  confessed  that  when  I  entered  upon 
practice,  polypharmacy  was  the  crying  sin  among 
our  medical  men. 

Recurring  now  to  blood-letting,  I  will  add,  that, 
while  Danforth  and  some  others  abstained  from  it 
entirely,  those  practitioners  who  were  regarded  as 
most  judicious,  employed  the  lancet  in  the  com- 


ON    THE    UTILITY    OF    MEDICINE.  55 

mencement    of    what    tliey    called    inflammatoiy 
diseases.     For  local  affections  they  directed  local 
bleeding.     None  of  them,  however,  bled  so  freely 
as  Dr.  Rush  and  his  disciples  did.     At  the  present 
day,  a  change  has  come  over  us.     I  can  hardly 
say  just   when  it   began.     For   the   last   twenty 
years,  at  least,  venesection  has  almost  gone  out  of 
use  among  us,  in  medical,  if  not  in  surgical  prac- 
tice.   The  use  of  leeches  and  cupping  also  has  very 
much  diminished  ;  so  that  I  doubt  whether  there 
is  a  quarter  part,  and  it  may  be  that  the  number 
of  leeches  directed  now  is  not  more  than  a  tenth 
part   of   the   number   directed    thirty   years   ago. 
Now  I  rejoice  that  blood  is  not  taken  away,  as  a 
matter  of  routine,   in  every  case  of  inflammatory 
disease,  without  regard   to   its   period.     I   rejoice 
that  our  physicians  do  not  direct  blood-letting,  be- 
cause the  pulse  is  thought  to  be  unhealthy.     It 
was  on  such  false  grounds  that  Rush  was  in  the 
habit  of  prescribing  this  evacuation.     The  benefit 
derived   from   bleeding,    to   a   reasonable   extent, 
bears  no  proportion  to  the  evils  produced  when  this 
practice  is  carried  to  excess.     Nevertheless,  I  feel 
persuaded,  from  my  own   observation  and  expe- 
rience, that  the  use  of  the  lancet  should  not  be  al- 
together abandoned.     It  is    true,   as   to  pleurisy, 


56  ON    THE    UTILITY    OF    MEDICINE. 

and  pneumony,  whicli  are  the  diseases,  for  which 
it  has  been  considered  most  appropriate,  that, 
when  confined  to  one  side,  and  where  no  other 
morbid  affection  exists  at  the  same  time,  in  an 
adult  of  a  heahhy  constitution,  these  diseases 
rarely  prove  fatal.  I  cannot  say  the  same  with 
regard  to  young  children.  In  them,  simple  and 
pure  pleurisy  will  sometimes  destroy  life,  and  still 
oftener,  pneumonitis  will  do  this,  and  even  severe 
and  extensive  bronchitis.  But,  in  the  adult, 
bleeding  on  the  first  or  second  day  of  the  disease, 
or  perhaps  even  on  the  third  day,  w^ill  somewhat 
shorten  the  disease,  and  will  more  certainly  dimin- 
ish its  violence.  In  young  subjects  I  am  entirely 
convinced  that  the  bleeding  diminishes  the  risk  of 
life.  I  am  aware  that  I  am  repeating  here  some 
things  which  may  be  found  in  my  tenth  letter. 
I  do  it  to  show  that  I  have  not  met  with  anything 
since  that  letter  was  w^ritten  to  alter  my  opinion. 
Let  me  here  note,  that  wuth  young  children,  it  is 
not  easy  to  take  blood  from  the  arm,  because  the 
veins  are  commonly  hidden  in  the  subcutaneous 
fat  of  children,  particularly  of  very  young  chil- 
dren. But  any  one,  who  will  take  the  trouble  to 
study  the  mode  of  performing  it,  may  effect  his 
object  in  these  subjects  by  opening  the  external 


ON    THE    UTILITY    OF    MEDICINE.  57 

jugular  vein,  around  which  he  will  not  find  any 
impediment  from  adipose  matter.  At  the  present 
day  as  I  have  already  said,  bleeding  is  very  much 
out  of  fashion  amongst  us  ;  and  I  am  aware  that 
it  may  excite  some  surprise  that  I,  who  mean  to 
co-operate  with  my  friends,  Dr.  Bigelow  and  Dr. 
Holmes,  in  discouraging  the  frequent  use  of  violent 
remedies,  and  in  trusting  to  the  efforts  of  nature 
in  very  many  cases,  should  give  so  much  commen- 
dation to  a  mode  of  treatment  generally  regarded 
as  the  most  violent,  and  therefore  as  the  most 
objectionable.  But,  in  the  first  place,  these  gen- 
tlemen do  not  decry  active  treatment  on  all 
occasions,  nor  do  I  know  that  either  of  them  has 
actually  proscribed  blood-letting.  I  know,  indeed, 
that  they  would  oppose  themselves  to  Sangrado  if 
he  were  to  reappear  on  the  earth,  and  either  of 
them  would  be  capable  of  putting  him  out  of 
countenance  by  ridicule,  as  well  as  of  putting 
him  down  by  sound  argument.  But  though 
Sangrado  and  his  follower.  Rush,  should  be 
opposed  by  all  sound  minded  men,  it  does  not 
follow  that  this  unfashionable  practice  can  never 
be  employed  with  advantage.  Looking  at  it  as 
a  violent  remedy,  let  me  say,  that  powei-ftil 
emetics   and  drastic    cathartics,   especially   if  fre- 


58  ON    THE    UTILITY    OF    MEDICINE. 

quentlj  repeated,  may  prove  more  pemianently 
depressing  and  injurious  to  the  constitution  than 
one  full  blood-letting ;  that  is,  taking  from  an 
adult  of  ordinary  vigor  a  pint  of  blood.  In  my 
opinion,  as  much  as  this,  and  sometimes  more, 
should  be  taken  at  once.  If  the  design  is  to  give 
the  remedy  a  fair  trial,  it  is  better  to  do  at  once 
all  that  is  requisite.  It  is  scarcely  ever  wise  to 
repeat  the  evacuation.  The  practice  of  repeated 
small  bleedings,  averaging  eight  or  ten  ounces, 
which  obtained,  I  believe,  in  fonner  times  on  the 
continent  of  Europe,  much  more  than  in  Great 
Britain,  or  in  this  country,  I  regard  as  very  in- 
jurious. By  this  practice,  the  evils  of  blood- 
letting are  produced  without  its  benefits.  For, 
usually,  more  blood  is  abstracted  ultimately  when 
this  mode  of  treatment  is  adopted,  while  there  is 
not  a  sufficient  impression  made  at  any  one  time 
to  check  the  disease  effectually. 

I  cannot  refrain  from  referrino-  ao-ain  to  what  I 
have  said  as  to  bleeding  in  young  children.  On 
this  point  I  ground  my  opinions  entirely  on  my 
own  experience.  When  I  began  practice,  I  was 
not  disposed  to  employ  bleeding  in  any  cases, 
especially  in  those  of  children.  But,  finding  that 
in   them  acute  inflammations  within  the   thorax 


ON    THE    UTILITY    OF    MEDICINE.  59 

were  often  fiital,  I  felt  myself  bound  to  make  a 
trial  of  tills  remedy,  which  had  been  approved  by 
many  men  of  sound  minds.  I  then  tried  bleeding 
in  subjects  of  all  ages,  and  the  opinions  above 
given  resulted  from  these  trials. 

Further,  with  regard  to  bleeding,  we  sometimes 
have  inflammatory  affections  within  the  thorax,  or 
elsewhere,  which  are  epidemic  and  of  a  character 
differing  from  that  of  ordinary  inflammation.     In 
such   epidemics,  blood-letting  is  not  so  useful  as 
in  common  inflammations  ;   and  often,  indeed,  it 
appears  to  be  hurtful.     The  most  remarkable  epi- 
demic of  this  sort,  which  I  have  ever  witnessed, 
occurred  in  New  England,  in  the  years  1812,  13, 
and  14.    This  epidemic  followed  that  of  the  spotted, 
or  petechial  fever.      This  affection  of  the  thoracic 
viscera  received  various  names,  according  to  the 
theories  adopted  by  those  who  applied  them.     It 
was  called   peri-pneumonia  notha,   typhoid  pneu- 
monia, bilious  pneumonia,  &c.,  &c.     From  post- 
mortem examinations,  as  well  as  from  the  symptoms 
durins:  life,  it  was  found  that  the  inflammation  was 
seated  sometimes  in  the  pleura,  sometimes  in  the 
substance  of  the  lungs,  sometimes  in  the  heart,  on 
its  inner,  or  its  outward  coat,  or  in  two  or  more  of 
these  parts  at  the  same  time.      Further,  it   was 


60  ON    THE    UTILITY    OF    MEDICINE. 

found  that  the  disease  ran  its  course  more  rapidly, 
often  much  more  rapidly,  than  common  inflam- 
mation in  the  same  parts.  Likewise,  from  the 
commencement  of  the  disease,  in  many  of  the 
cases,  the  prostration  of  strength  was  exceedingly 
great.  The  general  belief  among  medical  men 
was  that  patients  under  this  epidemic  disease  could 
not  bear  blood-letting,'  as  they  might  do  in  ordi- 
nary inflammations  of  the  lungs,  &c.  The  disease 
was  vastly  more  fatal  than  those  of  the  same  name, 
in  other  seasons.  So  far  as  my  limited  experience 
permitted  me  to  judge,  for  this  epidemic  prevailed 
much  less  in  this  city  than  in  many  other  places 
within  New  England,  a  vigorous  man  might  be 
bled  within  the  first  few  hours  of  the  disease,  not 
only  with  safety  but  with  advantage.  But  at  the 
end  of  ten  or  twelve  hours,  the  time  for  the  remedy 
had  passed  by.  A  great  majority  of  physicians 
who  saw  this  epidemic,  decried  blood-letting  alto- 
gether ;  but  I  suspected  that  they  did  so  without 
testing  the  remedy  at  the  very  onset  of  the  disease. 
I  was  not  alone  in  the  opinion  I  have  stated 
above. 

Let  it  now  be  borne  in  mind  that,  in  a  large 
proportion  of  the  occasions,  on  w^hich  I  recom- 
mend  the  employment  of  the  heroic  medicines, 


ON    THE    UTILITY    OF    MEDICINE.  61 

it  must  be  on  the  first  day,  or  at  a  very  early 
period  of  the  disease  that  is  to  be  treated.  If, 
according  to  the  popular  opinion,  every  disease 
has  its  remedy,  by  which  it  may  be  removed  at 
any  part  of  its  career,  the  case  would  be  vastly 
different ;  but,  if  you  have  to  do  with  a  disease, 
the  natural  duration  of  which  would  be  three,  or 
four,  or  five  weeks,  and  if  your  remedy  were  one, 
which  would  be  effectual  only  when  employed 
within  the  first  two  days  of  the  disease,  you  would 
meet  with  success  in  a  very  small  proportion  of  all 
the  cases  of  that  disease,  which  would  come  under 
your  care.  Ordinarily,  a  man  who  is  attacked  by 
an  acute  disease,  which  is  destined  to  become  very 
severe,  is  not  aware  of  the  evil  which  threatens 
him.  Hence,  he  neglects  to  call  for  medical  aid 
until  he  has  lost  the  precious  days  or  hours,  in 
which  relief  may  be  obtained.  The  patient  is 
unwilling  to  be  sick.  He  loves  to  deceive  himself, 
perhaps.  Oftentimes,  such  a  one  will  deny  the 
existence  of  what  we  call  the  subjective  symptoms 
of  disease ;  that  is,  of  those  symptoms,  which  the 
patient  knows  by  his  own  sensations,  and  which 
cannot  be  discovered  except  by  his  statements. 
Likewise,  when  the  first  symptoms  of  a  disease  are 
not  very  severe,  the  cautious  physician,  one  who  is 


62  ON    THE    UTILITY    OF    MEDICINE. 

unwilling  to  come  to  an  unwelcome  decision,  will, 
as  well  as  the  patient,  hope  for  the  best,  and  let 
the  same  precious  hours  pass  by,  —  often  the  only 
hours  in  which  medicine  can  be  employed  with 
great  advantage.  When,  from  any  cause,  the 
opportunity  for  active  treatment  has  been  lost, 
the  wise  course  is  to  pursue  the  expectant 
method.  It  is  when  it  becomes  evident  to  the 
physician,  that  the  fever  must  run  its  course, 
as  the  popular  phrase  is,  that  the  patient  and  his 
friends  become  anxious,  and  in  some  cases  clamo- 
rous for  active  and  powerful  treatment.  This  is 
the  time,  at  which  the  physician  must  take  a 
decided  stand.  Hence  it  is,  because  he  has  not 
had  an  opportunity  in  the  early  days  of  the  dis- 
ease, or  has  neglected  it,  that  the  largest  pro- 
portion of  patients  under  acute  diseases,  whether 
severe  or  mild,  must  be  treated  on  the  expectant 
plan.  Indeed,  this  is  commonly  more  necessary 
in  diseases,  which  are  severe  and  attended  by 
danger,  than  in  those  of  a  milder  character.  For 
instance,  in  a  severe  pneumonitis  one  cannot  em- 
ploy active  remedies  with  safety  after  the  second 
or  third  day,  because  it  is  then  too  late  to  arrest 
the  disease  ;  and  though  we  might  still  lessen  it 
by  active  remedies,  there  is  the  danger  that  we 


ON    THE    UTILITY    OF    MEDICINE.  63 

may  so  impair  the  powers  of  the  sick  man  that  he 
camiot  hold  out  through  the  Avhole  course  of  his 
malady.  But  in  a  bronchitis,  which  is  less  danger- 
ous than  a  pneumonitis,  there  is  no  such  risk,  and 
we  need  not  therefore  have  the  same  fear  of  active 
remedies  after  the  first  days. 

There  is  one  inflammatory  disease,  not  yet 
mentioned,  in  which  it  was  formerly  somewdiat 
common  to  take  blood,  but  in  which  it  is  very 
rarely,  if  ever  done  now.  I  refer  to  a  general 
acute  rheumatism,  or  rheumatic  fever.  In  that 
disease  there  may,  no  doubt,  be  some  temporary 
relief  from  bleeding,  though  even  that  is  not  cer- 
tain ;  but,  ultimately,  the  evil  is  much  greater 
than  the  good.  Such  is  the  result  of  my  expe- 
rience. In  acute  rheumatism  a  patient  is  most 
commonly  relieved  spontaneously  within  a  fort- 
night:  so  much  reheved,  that  he  thinks  himself 
nearly  well,  and  the  inexperienced  physician  will 
think  so  too.  This  is  one  of  the  cases,  where  a 
confidence  in  a  speedy  recovery  prevents  the  re- 
covery from  being  speedy.  For,  after  a  respite 
of  a  week,  more  or  less,  a  new  attack  of  the  dis- 
ease takes  place,  and,  as  in  the  first  instance,  the 
disease  shows  itself  in  succession  in  various  joints 
of  the  body,  large  or  small ;  sometimes  in  the  eyes, 


64  ON    THE    UTILITY    OF    MEDICINE. 

there  attacking  their  different  tissues  successively  ; 
and  not  unfrequently  it  reaches  the  heart,  affect- 
ing the  external  or  the  internal  membranes  of 
that  organ,  or,  more  rarely,  its  muscular  substance. 
A  third  attack  of  the  disease  may  follow,  after 
this  last  one  has  subsided,  and  this  may  not  be  so 
rapid  in  its  course ;  instead  of  passing  quickly 
from  one  articulation  to  another,  it  may  become 
permanent  in  one  or  more  of  them  for  many 
weeks  or  months.  Thus,  if  we  regard  rheumatism 
as  an  inflammation,  it  differs  from  other  grave 
inflammations,  in  the  early  part  of  the  disease 
especially,  in  that  it  does  not  remain  long  in  any 
one  part.  Also,  it  differs  because  it  does  not 
terminate  in  suppuration,  and  so  far  as  any  mate- 
rial is  thrown  out  upon  the  diseased  tissues,  the 
same  will  usually  be  removed  spontaneously  within 
a  short  time.  But  while  individual  parts  recover, 
something  remains  in  the  system  which  causes 
successive  attacks  in  different  parts. 

Now,  though  bleeding  employed  at  the  begin- 
ning may  hasten  the  recovery  in  the  elbow,  knee, 
or  other  part  which  is  first  affected,  the  evacuation 
does  not  prevent  the  disease  from  showing  itself 
in  new  parts.  The  question  might  be  asked,  by 
some  Sangrado  at  least,  if  larger  bleedings,  or  if 


ON    THE    UTILITY    OF    MEDICINE.  Q3 

a  frequent  repetition  of  the  bleeding  would  not  be 
more  successful.  It  would  not  be  easy,  I  believe, 
for  any  one,  except  Sangrado  himself,  to  try  this 
method  often.  But,  owing  to  accident,  I  knew  of 
one  instance  where  it  was  tried  to  a  large  extent. 
In  this  case,  the  part  first  affected  was  the  tunica 
conjunctiva,  and  the  inflammation  was  of  extreme 
violence.  The  other  tissues  of  the  eye  were  af- 
fected in  rapid  succession.  The  patient  was  a 
vigorous  young  man,  previously  in  good  health. 
There  was  no  reason  at  that  moment  to  think  of 
anything  else  than  a  common  inflammation,  com- 
mon in  kind,  though  not  in  degree.  Of  course, 
the  eye  seemed  to  be  threatened  with  destruction. 
The  most  vigorous  measures  were  called  for ;  the 
more,  as  the  sight  of  the  other  eye  had  been 
destroyed  some  years  previously  by  a  blow  upon 
the  organ.  Seven  pounds  of  blooji  were  taken 
away  within  the  first  five  days  of  the  disease. 
Then,  the  true  character  of  the  disease  was  shown 
by  a  rheumatic  attack  on  one  of  the  knees,  upon 
which  the  eye  rapidly  mended.  From  this  perio(^ 
the  disease  pursued  the  usual  course  of  acute 
rheumatism  with  great  violence,  and  within  a  few 
weeks  the  eye  took  its  turn  twice  more.  The 
patient  was  not  able  to  go  abroad  with  any  free- 
6 


66  ON    THE    UTILITY    OF    MEDICINE. 

dom  for  three  months,  and  then  with  a  palnfiil 
and  swollen  ankle.  So  far  as  one  case  can  go, 
this  one  shows  that  very  copious  bleeding  in  the 
early  part  of  the  disease  does  not  arrest  acute 
rheumatism,  but  rather  makes  it  worse.* 

Those,  who  hold  the  favorite  opinion  of  the 
present  day,  that  acute  rheumatism  has  its  origin 
in  a  morbid  state  of  the  blood,  will  readily  explain 
the  failure  of  relief  from  bleeding.  But  questions 
regarding  the  proximate  cause  of  disease,  I  am 
not  fond  of  discussing.  For  me,  the  experience 
sained  from  careful  and  honest  observation,  is 
more  satisfactory  than  any  the  most  plausible  and 
most  ingenious  hypothesis. 

Althouo-h  bleedinoj  is  not  to  be  recommended 
in  acute  rheumatism,  it  does  not  follow  that  the 
disease  may  not  be  relieved  by  any  other  treat- 
ment. So  far  as  I  know,  there  is  not  any  other 
which  can  be  recommended  with  entire  confi- 
dence. Yet,  in  a  good  proportion  of  cases,  if  the 
treatment  is  begun  at  the  very  commencement  of 
the  disease,  experience  justifies  some  hope  of  ad- 
vantage from  it ;  that  is,  that  there  is  a  chance  of 
diminishing  the  violence  of  the   disease,   and  its 

*  See,  in  Appendix,  the  case  of  Mr.   Prescott. 


ON    THE    UTILITY    OF    MEDICINE.  67 

length.  Various  remedies  are  thought  to  do  good, 
but  that  on  which  my  experience  leads  me  to  rely 
is  colchicum.  Other  active  cathartics  are  found 
beneficial,  but  none  so  much  so  as  this.  To  be 
effectual,  it  should  be  repeated  once  in  four  to  six 
hours,  until  it  brings  on  copious  discharges ;  and 
if  it  occasion  some  vomiting,  the  chance  of  success 
is  the  better.  Under  its  use,  profuse  perspiration 
will  commonly  occur-,  and  the  heat  of  the  surface 
is  diminished  at  the  same  time,  while  the  pain  is 
relieved  without  any  extension  of  the  disease  to 
new  parts.  In  consequence  of  all  this,  the  patient 
often  has  a  great  sense  of  weakness  and  exliaus- 
tion ;  but  if  the  use  of  the  medicine  is  stopped,  as 
soon  as  the  powerful  effects  occur,  he  will  usually 
be  restored  to  some  comfort  within  twenty-four 
hours.  Under  these  circumstances,  it  will  ordi- 
narily be  found  that  the  disease  has  a  lull,  and  if 
we  can  be  assured  that  it  would  not  return,  no  one 
would  deny  that  the  benefit  would  be  an  abund- 
ant compensation  for  the  evil  of  the  remedy.  The 
object  then  is  to  prevent  such  a  return.  For  this 
purpose  it  is  necessary,  in  the  first  place,  that  the 
patient  should  remain  on  his  bed,  and  be  kept 
free  from  all  disturbance  of  body  and  of  mind. 
Secondly,  his  food  should  be  of  the  mildest  kind, 


68  ON    THE    UTILITY    OF    MEDICINE. 

and  moderate  in  quantity,  for  one  or  two  days  at 
least.     After  that,  he  may  be  allowed  milk  and 
bread,  or  some  other  equivalent  vegetable  article. 
Thirdly,  sulphate  of  qmnia  should  be  administered 
with  a  view  to  prevent  a  recurrence  of  the  disease. 
I  will  not  say  that  this  always  succeeds,  yet  I  have 
never  perceived  any  inconvenience  from  the  trial 
of  it.     It  is  not  a  new  remedy  in  this  case.     It 
was  recommended,  I  think,  by  Dr.  George  For- 
dyce,  in  the  last  century ;  but  it  was  more  dis- 
tinctly  recommended   in   the   early   part  of  this 
century  by  Dr.  Haygarth,  of  Bath  ;  or,  to  speak 
more   correctly,    the  Peruvian  bark   was   recom- 
mended by  these  distinguished  physicians ;   for  in 
their  time  the  quinia  was  not  known.     That  this 
medicine  may  have  a  fair  chance,  it  should  be 
exhibited  at  first  in  very  full  doses,  as  it  is  in 
intermittent  fever.    In  the  first  twenty-four  hours, 
sixteen  or  twenty  grains  of  the  sulphate  should  be 
given.     The  whole  quantity  for  the  day  may  be 
divided  into  four  doses,  the  interval  between  the 
doses  being  four  or  five  hours. 

Most  persons  prefer  to  take  this  medicine  in  the 
form  of  pills,  although  some  prefer  a  solution,  in 
water.  If  the  patient  complain  of  dulness  in 
hearing,  or  of  unusual  sounds,   or  of  a  sense  of 


ON    THE    UTILITY    OF    MEDICINE.  69 

tension  in  the  ears,  the  dose  should  not  be  increas- 
ed;  otherwise,  four  grains  may  be  added  to  the 
previous  quantity  on  the  second  day.  The  dose 
may  be  increased  again  on  the  third  day,  if  no  in- 
convenience is  experienced  from  it.  Whenever 
any  very  decided  inconvenience  is  produced,  the 
quantity  should  be  diminished,  until  the  inconven- 
ience has  nearly  disappeared.  But  it  is  best  that 
the  medicine  should  be  continued  in  such  quantity, 
as  that  the  patient  may  be  sensible  of  its  effects  for 
four  or  five  days.  After  this,  the  dose  may  be 
gradually  diminished  for  six  or  eight  days,  when 
the  medicine  may  be  given  up.  If,  however,  the 
disease  should  return  in  any  considerable  force, 
under  the  use  of  the  medicine,  this  should  be  with- 
drawn. If  then  the  disease  appear  nearly  of  the 
same  force  as  during  the  first  attack,  the  attempt 
to  arrest  it  should  be  abandoned.  But  if  it  be 
evident  that  the  disease  is  lessened  in  violence,  the 
colchicum  may  be  used  again  in  such  doses  as  to 
operate  moderately,  and  on  the  subsidence  of  the 
rheumatic  affection  the  use  of  the  quinia  should 
be  resumed.  During  the  use  of  the  quinia,  care 
should  be  taken  to  keep  the  bowels  soluble,  and 
the  diet  should  remain  moderate  in  quantity, 
and  mild  in  quality.     All  animal  food  and  stim- 


70  ON    THE    UTILITY    OF    MEDICINE. 

ulating   liquors    should   be   withheld    during   this 
period. 

If  the  treatment  fail  to  be  useful,  or  if  the 
patient  should  not  be  brought  under  care  within 
the  first  few  days  of  the  disease,  he  should  be  left 
free  from  active  treatment ;  in  other  words,  the 
expectant  course  should  be  pursued.  As  the  dis- 
ease is  often  extremely  painful  and  prevents  sleep, 
opium  may  be  employed  as  a  solace.  By  many 
physicians,  this  is  the  only  drug  employed  in  acute 
rheumatism,  and  it  is  given  in  such  quantities  as  to 
keep  the  patient  free  from  severe  pain.  It  has 
seemed  to  me,  however,  that,  when  this  medicine 
is  used  constantly  and  freely,  the  evils  are  greater 
than  the  benefit.  It  does  not  shorten  the  period 
of  the  disease,  though  it  lessen  the  sufferings  that 
belong  to  it.  But  it  lessens  the  appetite  for  food, 
it  lessens  very  much,  and  often  destroys,  the  power 
of  digesting  food,  and  it  induces  great  consti- 
pation. Thence,  in  the  end,  it  occasions  much 
greater  debility,  more  true  exhaustion,  than  is  pro- 
duced by  the  operation  of  colchicum  in  the  early 
period  of  the  disease.  The  power  of  recovery 
seems  to  be  lost.  The  patient  may,  at  last,  lie  still 
in  his  bed  without  any  distinct  pain,  but  he  cannot 
turn  from  side  to  side,  he  can  scarcely  raise  his 


ON    THE    UTILITY    OF    MEDICINE.  71 

hand,  and  often  he  becomes  quite  incapable  of 
raising  his  head.  You  may  offer  him  food  under 
these  circumstances,  and  stimulants  with  food,  but 
he  cannot  take  them  with  pleasure,  and  for  a  long 
while  they  will  not  be  retained,  or  if  retained, 
they  will  produce  distress.  True,  it  is  not  always 
so.  There  are  people  who  can  bear  opium  with- 
out these  inconveniences,  but  they  are  the  happy 
exceptions. 

Various  other  remedies  are  recommended  in 
acute  rheumatism.  Of  late  years  both  acids  and 
alkalies  have  been  employed.  I  cannot  say  that  I 
have  witnessed  much  benefit  from  these,  or  from 
any  other  medicines,  with  the  exception  of  those  I 
have  already  mentioned.  In  cases  where  the 
disease,  though  acute,  has  been  local,  and  though 
severe,  has  not  been  attended  by  febrile,  or  consti- 
tutional affections,  I  have  very  commonly  seen 
relief  from  the  internal  use  of  the  resin  of  guaia- 
cum.  I  think  this  should  be  given  in  a  powder, 
and  not  in  the  form  of  tincture.  One  drachm 
may  be  taken  at  bed-time,  and  the  same,  or  half 
the  dose  may  be  given  in  the  morning,  if  the 
disease  be  severe.  It  should  be  given  until  it  pro- 
duces some  active  operation.  In  a  bad  case  some 
colchicum  may  be  added.     If  the  disease  do  not 


72  ON    THE    UTILITY    OF    MEDICINE. 

yield  in  three  days,  a  blister  should  be  drawn 
by  cantharides  as  near  as  may  be  to  the  part 
affected. 

In  ordinary  cases  of  local  rheumatism,  such 
active  treatment  causes  more  trouble  than  the 
relief  is  worth.  Here,  mild  measures  w^ill  suffice. 
Cover  the  diseased  part  with  substantial  new 
flannel,  and  two  thicknesses  of  it,  as  soon  as  the 
pain  is  distinctly  recognized.  By  so  doing,  in  a 
large  majority  of  cases,  the  pain  will  be  over- 
come within  twelve  or  twenty-four  hours.  The 
flannel  should  not,  however,  be  removed  in  less 
than  three  days,  and  It  is  well  then  to  remove 
only  half  of  it  at  a  time.  If  one  means  to 
follow  this  direction,  let  him  attend  to  every 
word  of  it. 

There  is  a  disease  which  has  been  called,  though 
it  is  not  the  only  disease  which  has  been  so  called, 
the  opprobium  medici ;  I  mean  the  gout.  It  has 
been  said  that  the  doctor  could  not  remove  it. 
Now,  if  this  be  said  in  respect  to  a  fit  of  the  gout, 
it  is  no  longer  true.  The  remedy  is  colchicum.  I 
should  be  supported  by  a  very  large  proportion 
of  the  medical  men,  who  have  tried  this  drug 
at  the  commencement  of  a  fit  of  the  gout,  in 
saying  that  it  can  give  relief.     No  doubt,  it  may 


ON    THE    UTILITY    OF    MEDICINE.  73 

sometimes  fail ;  but  it  is  most  rare  for  it  to  do 
so,  when  properly  employed.  The  dose  requisite 
is  diflferent  with  different  men,  and  in  a  new  case, 
the  medicine  must  be  tried  for  awhile  to  ascertain 
this  dose.  When  it  is  ascertained,  let  the  medi- 
cine be  employed  as  soon  as  the  attack  is  fairly  re- 
cognized, and  let  it  be  repeated  once  in  six  or  eight 
hours,  until  the  pain  has  fairly  given  wav,  or 
nausea  is  produced.  The  experienced  patient 
does  not  often  require  a  second  dose,  and  very 
rarely  a  third  dose.  I  have  been  told  by  gouty 
patients,  and  by  their  physicians,  that  they  have 
tried  this  remedy  without  success,  and  perhaps 
they  have  thought  that  injury  has  been  produced 
by  it ,  but  a  fair  and  careful  trial  has  at  once 
brought  about  a  change  of  opinion.  In  England, 
where  this  aristocratic  disease  prevails  much  more 
than  with  us,  I  believe  that  almost  all  physicians 
of  experience  agree  in  testifying  to  the  efficacy  of 
colchicum  in  gout.  By  many  it  is  thought  a 
specific. 

I  have  spoken  of  the  treatment  of  the  paroxysm 
of  the  gout,  but  it  is  much  more  important  to 
prevent  the  recurrence  of  the  paroxysm.  This  is 
attended  with  difficulty,  and  I  fear  there  is  not 
any   method,    by   which    we    can   with    certainty 


74  ON    THE    UTILITY    OF    MEDICINE. 

eiFect  this  object.  This,  we  are  told,  is  the  disease 
of  high  Hvers.  Tliis  is  not  said  without  some 
foundation,  but  it  does  not  require  great  excess 
to  produce  it.  You  do  not  meet  with  it,  or  very 
rarely,  among  men  who  work  with  their  hands ; 
not  among  common  laborers,  nor  among  mechan- 
ics. You  do  not  commonly  find  it  among  men 
who  use  spirituous  liquors  without  wine,  whether 
they  use  them  in  moderation,  or  in  excess.  You 
find  it  among  men  who  drink  wine,  or  other  fer- 
mented liquors.  I  mention  the  fermented  liquors 
because  in  one  instance,  at  least,  I  have  seen  it  in 
a  gentleman  who  had  not  used  wine  habitually, 
but  had  used  cider  freely.  But  the  occurrence  of 
gout  is  not  any  evidence  that  the  subject  of  it  has 
used  wine  to  excess.  This  malady  is  much  more 
common  in  Great  Britain  and  Ireland  than  in  this 
country.  I  was  ready  to  say,  that  it  occurs  among 
men  distinguished  above  their  fellows.  I  may 
say,  at  least,  that  among  men  much  distinguished 
it  is  extremely  common.  You  find  this  in  reading 
the  biographies  of  bishops  and  priests,  of  judges 
and  counsellors-at-law,  and  of  eminent  physicians; 
likewise,  and  perhaps  I  should  say,  more  particu- 
larly, amongst  distinguished  statesmen.  I  have 
Englishmen  in  my  mind  while  I  make  these  state- 


ON    THE    UTILITY    OF    MEDICINE.  75 

ments.  Among  them  I  believe  it  is  not  rare  to 
find  soldiers  and  sailors  subject  to  gout ;  not  those 
in  the  ranks,  and  not  the  mariners,  but  the  major- 
generals  and  the  admirals.  But  it  is  by  no  means 
so  common  in  these  two  classes,  as  among  the  great 
men  in  civil  life.  You  see,  then,  that  this  disease 
occurs  among  men  who  use  their  minds  on  im- 
portant subjects,  among  those  eminent  in  their 
respective  branches,  whose  mental  labors  are  often 
excessive,  and  especially  if  these  labors  are  attend- 
ed by  great  responsibilities,  and  give  rise  to  great 
anxiety.  The  influence  of  wine  in  producing 
this  disease  has  been  much  dwelt  upon,  and 
very  properly. 

I  have  said,  that  it  comes  to  those  who  do  not 
use  wine  to  excess  ;  and  I  have  an  impression, 
though  I  am  not  sure  about  it,  that  it  rarely,  if 
ever,  occurs  among  those,  who  are  in  habits  of  intox- 
ication from  wine.  Under  this  view  of  the  matter, 
one's  first  thought  would  be  to  advise  the  subject 
of  sout  to  abstain  from  wine  altooether.  The  onlv 
ground  of  hesitation  on  this  point  is,  that  there 
may  be  something  in  the  constitution,  or  circum- 
stances of  the  patient,  which  would  make  one  fear 
to  withhold  this  accustomed  stimulus.  But  can 
abstinence  in  this  respect  be  relied  on  with  entire 


76  ON    THE    UTILITY    OB^    MEDICINE. 

confidence  to  prevent  tlie  recurrence  of  the  dis- 
ease ?  It  cannot.  Ordinarily,  decided  benefit  will 
ensue  from  this  abstinence  ;  but  not  always.  The 
subjects  of  gout  are,  very  many  of  them,  persons 
of  sedentary  habits.  But,  also,  this  disease  is  hered- 
itary, and  hence  comes  upon  men,  who  are  very 
active.  The  son  suffers,  I  will  not  say  for  the 
sins,  but  for  the  unhealthy  habits  of  his  father. 
Hence  you  find  families  subject  to  it.  I  once 
knew  a  gentleman,  finely  made,  tall  and  stout, 
of  excellent  habits,  but  who  belonged  to  a  gouty 
family.  He  began  to  have  the  disease  very  early 
in  life.  He  was  a  man  of  firm  mind,  of  great 
resolution,  and  he  determined  to  avoid  such  suffer- 
ings, as  he  had  seen  among  his  family  and  friends. 
With  this  view,  he  avoided  fermented  and  dis- 
tilled liquors  entirely.  He  abstained  from  animal 
food,  and  he  led  an  active  life.  He  persisted  in 
this  course  for  a  series  of  years,  more  than  twenty 
years,  I  believe ;  perhaps  thirty.  Probably,  he 
did  better  than  if  he  had  not  been  thus  abstinent 
as  to  diet,  and  thus  active  in  his  habits.  Never- 
theless, he  suffered  severely  from  the  gout,  and  he 
did  not  reach  the  period  of  old  age.  I  state  this 
Cc-use  only  to  show  that  the  disease  is  not  main- 
tained   merelv    bv   the    use    of   wine.     I    should, 


ON    THE    UTILITY    OF    MEDICINE.  77 

however,  adv^ise  abstinence  from  this  Kquor  in 
every  case  where  there  were  no  obvious  objec- 
tions ;  but  I  should  advise  other  things  also.  The 
first  in  importance  among  these  other  things  is 
exercise  in  the  open  air,  active  and  habitual  ex- 
ercise, without  over-caution  as  to  the  weather. 
Next,  I  should  advise  moderation  and  regularity 
as  to  food.  In  certain  cases,  probably,  vegetable 
food  with  milk  would  be  the  most  beneficial  diet. 
In  all  cases  the  regular  excretions  should  be  pro- 
moted. Not  merely  the  alvine  excretions,  but 
also  those  from  the  kidneys,  the  skin,  and  the  lungs. 
Regularity  as  to  sleep  also  should  be  enjoined. 
But  this  sleep  should  be  in  the  night,  and  should 
be  begun  in  such  good  season  as  to  permit  early 
rising.  Something  gratefully  stimulating  should  be 
permitted  to  one,  who  abjures  the  indulgences  of 
the  table.  Now  there  is  one  stimulant,  which  is 
not  commonly  enjoyed  among  men  in  elevated 
stations,  although  it  seems  to  be  at  the  command 
of  all  mankind  ;  I  refer  to  the  morning  air.  I 
should  insist  that  a  man  who  seeks  to  gain  the 
vigor  by  which  he  can  resist  disease,  should  get  the 
benefit  of  air  and  exercise  daily,  before  he  has  yet 
engaged  in  any  close  application  of  his  mind  to 
business.     To  all  this  I  would  add,  what  perhaps  it 


78  ON    THE    UTILITY    OF    MEDICINE. 

is  impossible  for  some  men  to  regard,  that  is,  avoid 
over-work  and  avoid  anxiety.  But  how  can  the 
statesman,  how  even  can  the  man  engaged  on  the 
bench,  or  at  the  bar  in  a  court  of  justice,  and  I 
may  say,  perhaps,  how  can  a  physician  engaged 
in  extensive  practice  in  a  large  city,  how  can  any 
of  these  limit  his  labors  at  all  times  and  avoid  the 
anxieties,  which  seem  almost  inevitably  to  attach 
themselves  to  great  trasts  ?  Undoubtedly,  for 
many  men,  this  is  impossible.  The  soldier  takes 
the  risk  of  life.  Other  men  must  occasionally 
do  the  same.  Much  depends  on  one's  tempera- 
ment and  constitution  and  early  training.  But 
Avith  firmness  and  discretion,  something  can  be 
done. 

The  soldier,  who  exposes  his  life  in  battle,  may 
feel  that  it  is  quite  as  proper  to  put  his  health  and 
his  life  at  risk  under  the  continued  labors,  and  the 
heavy  anxieties  which  appertain  to  his  position. 
Let  it  be  so.  Temporarily  he  may  perform  his 
duty,  and  disregard  the  hazards  ;  but  it  rarely 
happens  tnat  the  soldier  is  called  to  pass  his  whole 
life,  or  many  years  in  succession,  under  these  un- 
favorable circumstances.  Wars  do  not  commonly 
continue  for  many  successive  years.  For  a  states- 
man the  difficulty  is  much  greater.    William  Pitt, 


ON    THE    UTILITY    OF    MEDICINE.  79 

living  in  a  turbulent  age,  not  having  a  hun- 
dred eyes,  could  hardly  find  time  enough  to  watch 
over  the  events  of  the  world,  the  great  events,  each 
one  of  which  it  was  necessary  for  him  to  know 
and  to  estimate  correctly,  and  at  the  same  time 
to  make  such  arrangements  as  to  obtain  the 
best  results  from  the  favorable  events,  and  to 
guard  against  the  evils  threatened  by  those  of 
an  opposite  character,  —  Wilham  Pitt,  I  say, 
striving  to  control  the  affairs  of  the  world  amidst 
storms  and  tempests,  could  not  turn  away  from  his 
official  engagements,  or  his  public  duties,  and  pay 
attention  to  his  own  health.  This  is  very  true. 
But  very  few  men  have  lived  in  the  world,  who 
for  a  series  of  years  have  been  situated  as  Pitt 
was.  He  was  not  an  emperor ;  not  an  autocrat ; 
he  Avas  the  servant  of  his  king,  responsible  to  him 
and  to  the  great  nation  under  him.  Napoleon, 
with  all  his  mighty  labors,  did  not  act  under  any 
master,  was  not  forced  to  consult  any  peers,  any 
fellows,  but  thought  and  acted  for  himself  as  a 
man  does  in  his  private  affairs.  Perhaps  to  Pitt 
the  trial  of  Ins  constitution  was  harder  than  that 
of  Napoleon.  But  both  of  them  were  bound  to 
incur  all  risks  of  personal  evils,  while  in  the 
service  of  their  country.     They  might   well  dis- 


80  ON    THE    UTILITY    OF    MEDICINE. 

regard  the  advice  of  a  physician.  But  they  are 
exceptions. 

Let  us  leave  this  fine  discussion  and  remember 
that,  if  one  would  avoid  a  fit  of  the  gout,  he  must 
endeavor  to  lead  a  calm  life,  and  rather  give  up 
the  pleasures  of  society,  than  to  incur  the  evils 
resulting  from  its  indulgencies,  its  cares  and 
anxieties. 

It  has  been  shown  that  in  some  acute  diseases 
from  the  beginning,  and  in  others  after  the  earliest 
days,  we  must  abstain  from  heroic  remedies.  But 
it  must  not  be  understood  that  in  pursuing  the 
expectant  course,  we  necessarily  avoid  the  use  of 
all  medicines  ;  still  less,  that  we  leave  the  patient 
without  any  directions  as  to  the  treatment  in  other 
respects.  By  leaving  a  case  to  nature,  it  is  not 
meant,  that  we  must  leave  it  to  chance.  There 
are  many  points,  on  which  directions  may  be 
necessary.  Accidental  aggravations  may  require 
to  be  removed,  or  relieved ;  and,  for  this  reason, 
medicine  may  be  called  for.  But  mostly  what  is 
called  the  hygienic  treatment  must  be  cared  for. 
Here,  it  may  be  asked,  do  we  mean  by  the  hygi- 
enic treatment  anything  but  good  nursing?  It  may 
be  said  in  reply,  that  this  treatment  is,  in  good  part, 
that  which  it  is  the  business  of  the  nurse  to  look 


ON    THE    UTILITY    OF    MEDICINE.  81 

after  ;  just  as  it  is  the  business  of  the  apothecary  to 
put  up  the  medicines  Avhich  are  ordered.  But,  in 
both  cases,  it  is  the  business  of  the  physician  to 
prescribe  what  is  to  be  done.  He  must  not  only 
point  out  the  general  principles,  on  which  the 
treatment  is  to  be  founded,  but  should  show  in 
each  case  how  these  principles  are  to  be  applied, 
and  should  descend  to  particulars  so  far  as  each 
case  may  require.  Let  me  specify  a  few  of  the 
points  to  be  regarded  as  such,  when  the  treatment 
is  conducted  on  the  expectant,  as  when  on  the 
active  plan.  Where  shall  the  patient  be  ?  Shall 
he  go  abroad,  or  stay  in  the  house  ?  Shall  he  sit 
up,  or  lie  on  the  bed  ?  What  shall  be  the  tem- 
perature of  his  room,  and  how  shall  ventilation  be 
managed  ?  What  nourishment  shall  he  have,  and 
how  often  may  it  be  given,  and  in  what  quantities  ? 
Although  we  abstain  from  the  use  of  strong  medi- 
cines to  produce,  or  to  check  evacuation,  yet  by 
mild  remedies  or  by  the  dietetic  treatment  we  may 
favor,  or  we  may  restrain  them.  On  these  points, 
and  on  many  others  analogous  to  them,  the  admi- 
rable Miss  Nightingale  gives  us  many  excellent 
directions.  She  professes  to  be  instnicting  the 
nurses.  She  tells  them  in  what  way  they  should 
manage  as  to  the  points  referred  to.    But  I  believe 


82  ON    THE    UTILITY    OF    MEDICINE. 

that  Miss  Nightingale  would,  in  reality,  look  to 
the  physicians,  for  the  care  of  these  things.  She 
is  too  modest,  or  too  polite  to  offer  her  advice 
directly  to  the  doctors.  But  she  may  be  said  to 
talk  to  the  nurses  within  their  hearing,  and  as  I 
presume,  with  the  hope  that  they  will  take  the 
hints  which  she  throws  out.  Until  she  has  estab- 
lished a  school  for  nurses,  she  will  hardly  be 
willing  to  entrust  them  with  the  regulation  of 
these  important  points.  I  will  acknowledge  that 
she  may  find  too  many  instances,  in  which  the 
doctors  fail  to  give  proper  directions  on  hygienic 
points  ;  but  if  she  were  to  speak  her  mind,  she 
would  say  to  them  that  this  was  their  business. 
It  is  nevertheless  tme  that  the  physician  should 
not  always  be  peremptory  in  his  orders  ;  he  may 
allow  to  the  nurses  some  latitude.  As  far  as  possi- 
ble he  should  consult  the  taste  and  feelings  of  his 
patient.  For  one,  who  is  suffering  under  disease, 
that  should  be  done,  which  is  most  agreeable,  so 
far  as  it  is  consistent  with  safety.  I  know  that  it 
is  too  common  for  those  about  the  sick  to  hesitate 
as  to  an  indulgence  of  the  feelings  and  taste  of  a 
sick  man ;  they  rather  presume  that  such  indul- 
gence would  lead  to  injuiy.  On  the  other  hand, 
I   have  long  been  persuaded   that  the  taste  and 


ON    THE    UTILITY    OF    MEDICINE.  83 

inclination  of  the  patient  should  be  indulged, 
unless  there  should  appear  some  obvious  and  de- 
cided objection.  The  burden  of  proof,  that  indul- 
gence would  be  wrong,  must  be  thrown  on  those, 
who  raise  the  objection.  But  it  is  by  the  physi- 
cian, and  not  by  the  patient,  that  the  final  decision 
should  be  made ;  as  on  the  physician  the  respon- 
sibility should  rest. 

I  avail  myself  of  this  opportunity  to  make  a  few- 
remarks  on  the  diet  of  the  sick.  By  one  class  of 
people,  those  in  and  those  out  of  the  medical  pro- 
fession, the  fear  is  that  the  sick  man  will  be  allowed 
too  much  to  eat  and  drink,  or  such  as  he  cannot 
digest,  or  such  as  fi'om  its  quantity  will  aggravate 
his  disease.  By  another  class  it  is  feared  that  he 
will  not  be  supplied  with  food  sufficiently  nutri- 
tious, or  will  be  too  much  limited  in  quantity. 
Now,  I  take  it,  that  in  an  acute  disease,  at  the 
commencement  of  it,  the  stimulus  of  food  may 
increase  the  disease ;  so  that  from  the  first  to  the 
sixth  or  eighth  day,  according  to  the  character  of 
the  disease,  it  is  best  that  the  food  be  small  in 
quantity,  mostly  liquid  in  foiTn,  and  mild  in  quality. 
Besides,  at  this  period,  the  stomach  will  not  act 
well  on  solid  food,  while,  if  the  food  be  liquid,  it 
may  be  passed  through  the  canal  with  comparative 


84  ON    THE    UTILITY    OF    MEDICINE. 

ease.  But,  after  the  early  period,  the  case  is  to 
be  regarded  in  a  new  hght.  Then  food  should  not 
be  withheld  from  the  fear  of  aggravating  the  disease 
by  its  stimulating  property ;  though  it  should  be, 
if  appetite  is  entirely  wanting;  and  that  only 
should  be  furnished  which  is  agreeable  to  the 
taste.  Under  these  conditions,  it  may  be  given, 
but  with  caution  ;  for  the  stomach  will  not  always 
digest  food,  even  when  the  patient  craves  it,  and 
when  it  proves  grateful  to  his  taste.  At  first  then 
it  should  be  given  in  small  quantities  once,  or  at 
most  twice  in  a  day.  In  proportion  as  the  patient 
bears  it  well,  the  quantity  may  be  slowly  in- 
creased ;  and  so  may  the  frequency  of  the  meals. 
If  the  food  be  solid,  it  should  never  be  given 
oftener  than  once  in  four  hours  ;  and  then  not 
in  the  night  hours,  unless  the  quantity  is  very 
limited.  Under  similar  circumstances,  when  fer- 
mented and  spirituous  liquors  are  craved,  they 
may  be  given,  such  as  are  most  grateful ;  at  first 
in  small  quantities.  The  extent,  to  which  these 
liquors  may  be  used  with  advantage,  is  very  vari- 
ous ;  the  limits  depend  partly  on  the  previous 
habits  of  the  patient  in  the  use  of  them.  There 
are  instances,  now  and  then,  in  which  good  wine 
is  not  only  borne  well  by  a  convalescent,  but  in 


ON    THE    UTILITY    OF    MEDICINE.  85 

which  it  seems  essential ;  —  in  which  he  is  so 
evidently  benefitted  by  it,  that  he  may  be  allowed 
a  bottle,  and  even  more  than  that,  in  the  twenty- 
four  hours,  for  many  days  in  succ^ession.  In  this  I 
have  reference  to  good  Sherry,  Madeira  or  Port 
wine.  But  it  is  not  wise  to  lead  the  patient  to 
such  large  potations,  unless  he  is  obviously  more 
comfortable  for  the  indulgence.  It  is  not  merely 
those  who  are  accustomed  to  drinking  wine,  who 
can  bear  this  free  use  of  it.  I  have  in  a  few 
instances  seen  teething  children,  much  wasted 
and  much  exhausted  by  cholera  infantum^  take 
wine  to  the  amount  of  a  pint  a  day  for  many 
successive  days,  with  unquestionable  benefit. 

I  have  not  exhausted  my  subject.  Far  from  it. 
There  are  many  more  medicinal  drugs,  too  good 
to  be  expunged  from  the  list  of  the  materia  medlca, 
which  I  might  mention.  Among  the  more  power- 
fril  of  these  are  Elaterium,  Digitalis,  Diluted  Hy- 
drocyanic Acid  and  Iodine  ;  to  which  I  may  add 
Sulphuric  Ether  taken  by  inhalation.  All  of 
these  may  be  occasionally  employed  by  discreet 
men  ;  men  who  are  willing  to  study  the  mode  of 
using  them,  the  effects  to  be  expected  from  them, 
and  the  extent  to  which  they  may  be  given. 
Among  milder  drugs  may  be  mentioned  the  Spirit 


86  ON    THE    UTILITY    OF    MEDICINE. 

of  Nitric  Ether,  tlie  compound  Spirit  of  Ether,  the 
Solution  of  Acetate  of  Ammonia,  Valerian,  and 
Assafetida,  as  old  friends,  whom  I  would  not  Hke 
to  part  with.  The  same  may  be  said  of  Mustard, 
the  Water  of  Ammonia,  Croton  Oil,  Chloroform 
and  Cantharides,  for  external  use.  Nor  should 
water,  pure  or  medicated,  cold  or  hot,  employed 
as  a  partial,  or  general  bath,  be  omitted  in  the  list 
of  remedies  not  to  be  dispensed  with.  Many  other 
articles,  without  great  pretensions,  are  often  ad- 
ministered to  the  great  satisfaction  of  the  sick. 

I  may  also  bring  to  view  other  morbid  affections, 
besides  those  mentioned  in  this  letter,  or  in  the 
series  of  letters  formerly  addressed  to  you,  from 
which  the  subjects  of  them  may  be  relieved  wholly, 
or  in  part,  by  the  proper  administration  of  articles 
contained  in  our  apothecaries'  shops.  For  instance, 
there  is  the  whole  tribe  of  cutaneous  diseases,  for 
which  the  Specialists  would  show  you  that  much 
benefit  may  be  afforded  by  remedies,  some  of  them 
external,  some  internal.  If,  now  and  then,  it  be 
true  that  those,  who  offer  instruction  in  regard  to 
diseases  of  this  tribe,  are  too  confident  in  pointing 
out  the  remote  causes  of  these  diseases,  or  in  the 
means  directed  for  the  cure  of  them,  —  it  is  cer- 
tainly true  that,  in  many  instances,  the  evidence  of 


ON    THE    UTILITY    OF    MEDICINE.  87 

the  benefit  produced  is  more  obvious,  than  in  most 
diseases  of  other  descriptions.  This  success  is 
easily  explained,  when  we  consider  that  the  dis- 
eased parts  are  exposed  to  examination  much  more 
perfectly,  than  the  internal  parts  of  the  body. 
Hence  the  diagnosis  is  comparatively  easy,  and 
the  diagnosis  of  the  different  stages  of  a  disease,  — 
a  circumstance  which  it  is  always  very  important 
in  regard  to  the  treatment,  —  may  be  much 
more  certainly  ascertained  than  in  other  diseases. 
So  likewise  the  effect  of  remedies  can  be  more 
satisfactorily  demonstrated,  in  treating  diseases 
of  the  skin,  than  in  treating  those  of  the  in- 
ternal organs. 

Remarks,  somewhat  the  same,  may  be  made  in 
respect  to  the  treatment  of  other  local  diseases, 
called  at  the  present  day  Speeialities,  such  as  dis- 
eases of  the  eyes  and  of  the  ears. 

I  am  aware  that  it  is  objected  to  the  Specialists 
that  they  are  apt  to  make  greater  pretensions  to 
skill,  than  are  justified  by  the  result  of  their  treat- 
ment. No  doubt  this  sometimes  happens.  This 
happens  partly  because  they  are  honestly  deceived, 
as  men  are  always  liable  to  be,  when  their  attention 
is  confined  to  a  very  limited  sphere.  But,  it  must 
be  confessed  that  it  sometimes  happens  from  less 


88  ON    THE    UTILITY    OF    MEDICINE. 

creditable  causes.  A  man  with  a  good  address,  a 
due  share  of  low  cunning,  or  a  due  share  of  bold 
impudence,  does  not  find  it  difficult  to  deceive 
persons  suffering  under  disease.  Yet,  from  all 
that  I  have  learned  from  the  Specialists,  I  have 
been  led  to  the  conclusion  that  they  can  show  us 
many  cases,  in  which  medicine  can  be  employed 
with  unequivocal  benefit. 

To  what  conclusions  have  we  arrived.?  First. 
I  have  admitted  the  abuses  of  medicine.  It  is, 
though  much  less  than  formerly,  given  too  much 
as  a  matter  of  course  to  all,  who  apply  to  the  phy- 
sician for  aid ;  and  powerful  drugs  are  adminis- 
tered too  often,  without  bearing  in  mind  that  they 
will  certainly  do  some  harm.  This  certain  evil 
should  be  compared  with  the  uncertain  benefit, 
which  we  are  justified  in  expecting  from  them.  It 
becomes  every  medical  man  to  keep  these  consid- 
erations fairly  before  his  mind,  when  making  his 
prescriptions.  I  have  flattered  myself  that  we  are 
not  peculiarly  subject  to  reproach  on  this  head,  in 
this  region  of  the  civilized  world.  But  I  know 
how  readily  all  men  take  to  their  hearts  such  sweet 
flatteries  as  this. 

Secondly.  I  have  endeavored  to  point  out  the 
importance  of  resorting  to  >yhat  I  have  called  the 


ON    THE    UTILITY    OF    MEDICINE.  89 

hygienic  treatment,  in  all  cases  admitting  the  use 
of  it.  This  I  have  recommended  especially  in 
chronic  diseases,  maintaining  that,  in  very  many 
cases,  the  best  chance  for  relief  may  be  found  in 
the  promotion  of  the  general  vigor.  By  this  the 
system  may  be  enabled  to  overcome  the  disease  ; 
or,  where  this  cannot  be  done,  to  delay  as  long 
as  possible  its  fatal  termination. 

Thirdly.  I  have  expressed  my  conviction  that 
by  medical  treatment,  often  by  the  efficient 
use  of  powerful  drugs,  sometimes  by  blood-letting, 
we  may  frequently  succeed  in  diminishing  the 
violence,  in  lessening  the  suffering,  and  in  short- 
ening the  duration  of  diseases.  But  I  have  dis- 
tinctly stated,  and  as  forcibly  as  I  could,  that  it 
was  only  at  the  commencement  of  a  disease  that 
the  treatment,  above  described,  could  be  employed 
with  any  just  hope  of  success.  In  doing  this,  I 
hope  that  I  have  been  clearly  understood  as  re- 
ferring to  the  first  days  of  the  actual  disease,  not 
to  the  first  days  of  the  physician's  attendance 
on  it. 

Fourthly.  I  have  brought  into  view  the  self- 
limited  diseases,  of  which  Dr.  Bigelow  has  treated, 
in  which  certain  processes  must  be  gone  through, 
and  which  medicine  cannot  arrest.     I  have  stated, 


90  ON    THE    UTILITY    OF    MEDICINE. 

however,  that  we  can  sometimes  diminish  the 
sufferings,  and  perhaps  also  the  danger  attending 
these  diseases,  when  these  are  passing  beyond 
certain  boundaries.  Otherwise,  these  diseases  are 
to  be  left  to  their  own  course,  only  guarding 
against  such  things  as  would  aggravate,  or  pro- 
long them. 

Fifthly.  When  diseases  are  brought  under  the 
treatment  of  a  physician,  after  the  period  during 
which  active  measures  are  found  useful,  or  when 
such  treatment  has  done  all  that  it  is  capable 
of,  the  expectant  mode  of  cure  should  be  relied 
upon. 

To  show  the  claims  of  medicine  to  the  character 
of  a  useful  art,  I  have  given  an  account  of  the 
uses,  which  may  be  made  of  some  of  the  most 
pow^ei*fal  drugs  employed  among  us  at  the  present 
day.  Subsequently,  I  pointed  out  some  of  the 
most  common  diseases,  in  which  I  have  thought 
medicinal  drugs,  as  well  as  other  treatment,  may 
be  used  w^ith  benefit.  I  have  given  the  results 
at  which  my  own  mind  has  arrived.  I  have  not 
pretended  to  demonstrate  the  justness  of  my  con- 
clusions. Nor  have  I  brought  forward  any  system 
of  medical  science.  I  am  not  capable  of  so  doing. 
I  think  I  may  say  more  ;  —  viz :  that  our  knowl- 


ON    THE    UTILITY    OF    ME1)ICI^'E.  91 

edge  at  the  present  day  does  not  justify  the 
attempt  to  bring  forward  any  such  system.  I  do 
not  deny  that  we  have  much  vahiable  knowledge 
in  the  various  branches  of  medicine.  I  maintain 
the  contrary  opinion.  But,  as  I  stated  in  tlie 
first  part  of  this  letter,  our  acquaintance  with 
physiology  and  pathology  is  limited  and  imper- 
fect ;  and  these  are  the  fundamental  branches. 
Of  course  the  same  must  be  true  in  regard  to 
therapeutics.  We  do  not  know  enough,  as  to 
either  of  these  branches,  to  enable  any  one  to  offer 
a  satisfactory  system  of  rational  medicine.  In 
many  instances,  certainly,  our  practice  is  founded 
on  experience  alone.  In  the  good  sense  of  the 
word,  our  practice  is  empirical.  Happily  this  is 
often  sufficient.  If  we  know  that  cinchona  wdll 
ai-rest  an  intermittent  fever,  have  we  not  good 
cause  to  be  satisfied,  although  we  cannot  answer 
all  the  questions,  which  may  be  put,  in  regard 
to  the  etiology  and  the  pathology  of  that  dis- 
ease, or  in  regard  to  the  inodus  operandi  of  the 
cinchona. 

There  is  one  acknowledgment,  which  has,  I 
think,  been  implied  in  what  I  have  already  writ- 
ten ;  but  I  choose  to  make  it  in  distinct  terms. 
This  is,  that  in  very  many  instances,  in  which  the 


92 


ON    THE    UTILITY    OF    MEDICIXE. 


aid  of  a  physician  is  invoked,  it  is  certain  that  he 
cannot  remove  the  disease.  In  some  instances 
this  is  because  he  is  called  too  late ;  unhappily  in 
very  many  it  is  because  the  disease  will  very  rare- 
ly, perhaps  never,  yield  to  medical  skill.  Yet, 
even  in  these  forlorn  cases,  the  art  of  medicine  is 
not  useless.  On  many  points  there  is  a  choice  as 
to  the  course  to  be  pursued.  Life  may  be  pro- 
longed by  wise  care,  however  hopeless  the  case. 
What  is  more  important,  by  art  the  sufferings 
may  be  mitigated,  and  the  patient  be  comforted, 
though  the  disease  cannot  be  arrested.  To  many 
persons,  who  know  they  have  a  disease,  which  is 
without  a  remedy,  it  affords  much  consolation  to 
have  one  to  watch  over  them,  who  understands 
their  sufferings,  and  who  is  daily  studying  to 
soothe  them.  The  faithful  care  of  nurses,  and 
the  kind  sympathy  of  friends,  are  often  still  more 
important ;  but,  in  ^me  sad  cases,  all  are  not  too 
much  to  uphold  the  strength,  or  to  soften  the 
anguish  of  a  beloved  one  in  the  last  days  and 
hours  of  life. 

In  conclusion,  may  I  hope  that  you  will  agree 
with  me  that  there  does  exist  much  valuable 
knowledge  in  regard  to  the  treatment  of  the  sick. 
Let  us  not  throw  this  aside,  because  it  is  imper- 


ON    THE    UTTT/ITY    OF    MEDICINE.  93 

feet;    l)L'cause   it   will    not   satisfy  those,    who  are 
critically  scientific  in  their  requirements.     There 
are  results  of  personal  experience,  of  w^hich  each 
medical  man,  or,  at  least,  many  medical  men  can 
furnish  a  part  ;  there   is  much  of  this  sort  which 
has    been    accumulating  through    ages.     What  I 
have  stated  in  respect  to  diseases  and  their  treat- 
ment, is  grounded  on  this  sort  of  experience.     It 
would  be  too  absurd  were  I  to  pretend  that  I  have 
gathered,  or  discovered,  all  which   I  have  stated. 
With  me,  as  with  my  brethren,   most  of  w^hat  1 
know  has  been  derived  from  others.     But  then  I 
have  also  been  told  by  others  much,  which  I  have 
not  found  to  be  true.     In  general  terms  I  may 
say  that  the  statements,  I  haA'e  made,  have  been 
confirmed  by  my  own  observation,  or  experience. 
I   have  not  offered  proofs  ;  I  ofPer  only  opinions. 
I  claim  to  have  formed  these  opinions  after  much 
and  careful   observation.      I    claim  to  have  been 
diligent  and  careful ;  but  there  is  no  doubt  that  I 
have  made   mistakes,  and  I  will  thank  any  one, 
who  will  point  them  out  to  me.    I  never  suspected 
that  I  was  possessed  of  any  extraordinary  powers, 
or  talents.     But  I  do  claim  an  honest  devotion  to 
the  pursuits  of  my  calling,  and  a  sincere  love  of 
truth.     I  like  to  compare  myself  to  an   old  gar- 


94  ON    THE    UTILITY    OF  MEDICINE. 

dener,  who  has  sedulously  devoted  himself  to  rais- 
ing the  flowers  and  the  finiits,  and  still  more  the 
kitchen  vegetables  of  the  plat  of  ground  under 
his  charge ;  who  has  listened  to  the  suggestions  of 
the  scientific,  and  has  been  wilhng  to  follow  them 
in  making  his  experiments,  exercising  due  caution 
when  those  experiments  appeared  to  be  attended 
with  risk  of  evil,  or  likely  to  involve  too  much 
expense;  and  who,  at  lasi,  points  out  to  those 
engaged  in  the  same  pursuit  the  best  opinions  and 
practices  he  has  been  able  to  arrive  at. 


THE    END. 


NOTES 


NOTES. 

I  TRUST  that  the  following  papers  will  be 
found  interesting  on  account  of  the  subjects  of 
them.  With  the  exception  of  the  article  in 
respect  to  Washington,  they  all  have  reference 
to  the  preceding  letter;  but  I  have  thought 
it  best  to  leave  them  to  be  read  after  the  letter, 
and  therefore  did  not  place  on  its  pages  any 
notice  of  them. 

In  the  letter,  I  have  frequently  mentioned  the 
hygienic  treatment  of  the  sick.  By  that  I  meant 
a  treatment  as  to  diet,  regimen,  &c.,  founded  on 
the  principles  of  that  branch  of  medical  science 
called  hygiene.  By  this  mode  of  treatment  we 
often  aid  the  spontaneous  efforts  of  nature  in  over- 
coming disease.  The  two  first  notes  are  given 
partly  to  show  that  I  have  always  paid  great 
regard  to  the  hygienic  treatment.  I  have  not 
become  tired  of  administering  medicine  ;  I  am  not 
incredulous  as  to  its  utility,  although  I  do  not  use 
it  so  freel}^  as  I  did  in  my  early  years. 

9  [97] 


98  NOTES. 

The  first  note  contains  an  account  of  the  first 
important  case,  which  came  under  my  care,  and 
it  will  be  seen  that  I  then  paid  great  regard  to 
the  treatment  just  mentioned.  I  would  not  how- 
ever have  given  this  case  for  that  purpose  only. 
My  fellow  citizens  in  Boston  will  see  other  reasons 
for  publishing  it. 

The  second  note  is  given  to  show  that,  when  I 
had  been  in  practice  forty-six  years,  I  continued 
to  hold  the  same  regard  for  the  hygienic  treat- 
ment. It  is  copied  from  the  British  and  Foreign 
Medical  Review,  No.  XL  III.  pubhshed  in  July, 
1846.  In  the  number  of  that  Review  for  Janu- 
ary, 1846,  the  Editor,  Sir  John  (then  Dr.  John) 
Forbes,  had  published  his  celebrated  article  on 
the  subject  of  Homoeopathy.  I  had  previously 
had  some  correspondence  with  Dr.  Forbes,  and 
immediately  after  reading  that  article  I  wrote  to 
liim  expressing  the  great  satisfaction  it  had  given 
me.  My  letter  was  not  designed  for  publication, 
as  he  saw  ;  but  he  replied  to  it  at  once  and  asked 
my  consent  to  his  printing  some  extracts  from  it 
in  his  Journal.  This  explains  the  appearance,  in 
that  excellent  periodical,  of  the  paragraph,  which 
makes  up  the  second  note  given  in  these  pages. 

The  third  note  contains  some  remarks  on  the 


NOTES.  99 

care  necessary  in  getting  reports  regarding  pa- 
tients under  treatment,  and  on  nurses.  These 
remarks  I  wished  to  offer  for  their  own  sake  ; 
but  I  confess  that  my  main  object  was  to  bring 
into  view  the  character  of  one,  whom  I  have 
lono;   considered  a  model  nurse. 

The  fourth  note  contains  an  account  of  the 
ailments  and  death  of  the  late  William  H.  Pres- 
cott,  Esq.,  the  celebrated  historian.  It  is  his  case, 
which  was  referred  to  in  the  preceding  letter,  as 
an  instance  of  acute  rheumatism  treated  at  its 
commencement  by  very  copious  blood-letting. 

Soon  after  Mr.  Prescott's  decease  my  friend 
George  Ticknor,  Esq.,  requested  me  to  furnish 
him  with  a  medical  account  of  Mr.  P.  's  case. 
Mr.  Ticknor  wanted  this  to  aid  him  in  preparing 
a  biography  of  our  lamented  friend.  I  gave  to 
him  my  statement  in  the  form  of  a  letter,  which  is 
copied  below.  I  found  that  Mr.  Ticknor's  work 
would  not  be  published  for  some  time,  and  as  I 
wished  to  bring  Mr.  Prescott's  case  before  my 
professional  readers,  I  begged  the  favor  of  him  to 
allow  me  to  use  it  in  this  way.  He  very  kindly 
consented  to  my  wish,  with  the  proviso  that  he 
should  still  use  the  whole,  or  any  part  of  my 
letter,  as  he  should  think  proper. 


100  NOTES. 

There  is  a  fifth  article  which  is  not  a  note  to 
tlie  letter.  It  is  a  distinct  affair.  It  contains  an 
account  of  the  last  sickness  and  death  of  General 
Washington.  This  was  written  by  me  about  a 
year  ago,  at  the  request  of  the  Hon.  Edward 
Everett,  to  be  used  by  him  in  his  Life  of  Washing- 
ton. It  is  referred  to  by  Mr.  E.  in  that  work, 
and  is  printed  in  an  appendix  to  it.  Copies  of  it 
have  been  sent  by  me  to  various  friends,  in  a 
pamphlet  form.  These  were  printed  for  me  in  a 
larger  type  than  in  the  Memoir,  expressly  for 
private  use,  by  Mr.  Everett. 

For  this  unexpected  favor  I  could  not  but  feel 
very  grateful  to  my  respected  and  learned  friend  ; 
but,  as  often  happens,  emboldened  by  one  favor  I 
asked  for  another.  After  I  had  obtained  Mr. 
Ticknor's  leave  to  make  use  of  my  letter  to  him, 
it  occurred  to  me  to  ask  Mr.  Everett's  permission 
to  add  to  this  volume  the  paper  on  Washington's 
case.  I  could  not  say  that  it  had  any  reference  to 
my  new  letter  to  a  young  physician  ;  but  I  thought 
that  it  mio-ht  reach  some  medical  men,  who  would 
not  otherwise  see  it.  The  subject  is  one,  in  which 
I  have  a  right  to  suppose  that  every  man,  but 
especially  every  medical  man,  must  feel  a  strong 
interest. 


NOTE    I. 

I  am  induced  to  give  the  history  of  the  case 
which  follows  from  several  considerations.  It  was 
and  is  interesting  to  me  on  personal  accomits ;  it 
was  the  first  important  case  which  came  mider  my 
care  when  I  entered  on  the  duties  of  my  pro- 
fession, and  it  relates  to  one  whose  memory  will 
always  be  held  in  regard  in  our  city.  I  will  add 
that  it  is  one  of  the  instances,  of  which  I  have 
since  seen  very  many,  which  teach  us  not  to 
despair,  although  the  appearances  of  danger  may 
seem  very  great.  We  meet  with  some  diseases, 
which  scarcely  permit  any  hope,  such  as  tubercles, 
malignant  diseases  of  various  sorts,  hydrophobia, 
tetanus,  &c.  In  such  cases,  the  best  encourage- 
ment may  be  founded  on  a  hope  that  we  have 
erred  in  our  diagnosis.  But,  when  dealing  with 
diseases,  which  are  not  so  uniformly  fatal,  it  will 
be  found  that  more  than  three  out  of  four  of  the 
instances  of  sickness,  which  are  regarded  by  the 
fiiends  of  the  patient  as  very  dangerous,  ultimately 
terminate  in  recoveiy.     Hence  in   bad  cases,  we 

[101] 


102  NOTES. 

are  justified  in  being  hopeful ;  and  it  is  right  for 
the  physician  to  encourage  hope  in  the  patient  and 
his  friends.  He  need  not  deny  that  there  is 
danger,  but  he  is  justified  in  looking  at  the  bright 
side,  and  it  gives  to  the  patient  a  better  chance  of 
recovery.  I  know  that  some  of  my  brethren  are 
fearfiil  of  pursuing  this  course,  as  it  may  subject 
them  to  censure,  if  the  result  is  unfavorable ; 
whereas,  if  the  patient  recovers  after  he  has  been 
despaired  of,  he  and  his  friends  are  repaid  for  all 
their  anxiety.  But  there  is  no  fear  that  recovery 
from  a  severe  sickness  will  not  bring  pleasure 
enough  to  the  parties  concerned,  and  I  regard  it 
as  the  duty  of  the  physician  to  run  a  little  risk 
of  reproach  now  and  then,  rather  than  keep  the 
parties  more  anxious  than  they  need  to  be  for 
several  successive  weeks,  or  days,  or  even  hours. 

One  reason  for  writing  this  note  is  that  the 
treatment  was,  in  very  great  part,  conducted  on 
hygienic  principles.  I  wish  to  show  that  my 
regard  for  these  principles  has  not  arisen  in  my 
old  ase,  from  a  distrust  of  the  benefits  of  medicinal 
treatment ;  but  that  I  began  life  with  feelings  of 
great  confidence  in  them.  That  confidence  has 
never  left  me,  while  experience  has  made  those 
principles  more  fiilly  and  more  distinctly  known 
to  me. 


NOTES.  103 

I  went  to  London  in  October,  1799,  to  pursue 
professional  studies  there.  I  returned  home,  and 
commenced  the  practice  of  medicine  about  the 
first  of  October,  1800.  When  I  went  away  my 
father  had  one  grandcliild  only,  a  boy  about 
five  months  old,  then  bright  and  healthy,  though 
small.  He  was,  of  course,  an  object  of  great 
interest  in  my  father's  family.  On  my  return 
home,  I  found  him  wofully  altered.  His  appear- 
ance shocked  me.  He  was  very  pale,  much 
emaciated  and  exhausted.  His  skin  was  flabby, 
and  seemed  to  hang  in  folds  around  his  bones. 
His  appetite  was  capricious,  his  food  was  very 
imperfectly  digested,  not  always  retained  in  his 
stomach,  and  did  not  nourish  liim.  His  dejections 
were  frequent,  loose,  changing  in  character  from 
hour  to  hour,  made  up  of  undigested  food,  of 
mucus  and  watery  fluid,  varying  in  color,  mostly 
green,  and  never  healthy  in  consistence,  color,  or 
odor.  His  blight  blue  eyes  had  not  lost  all  their 
spirit,  but  otherwise  his  countenance  exhibited 
marks  of  great  wretchedness.  By  turns  he  was 
languid  and  fretful.  His  nights  were  wakeful, 
and  the  sleep  he  got  was  uneasy  and  unrefresh- 
ing.  It  was  a  bad  case  of  cholera  infantum. 
Such  was  his  appearance,  that,  dear  as  he  was  to 


104 


NOTES. 


me,  the  son  of  a  sister  near  my  own  age,  and  my 
earliest  playfellow,  I  felt,  on  first  looking  at  him, 
as  if  it  would  be  a  happiness  to  see  him  die.  The 
case  seemed  to  be  desperate.  I  had  acquired  some 
familiarity  with  the  subjects  of  the  disease  during 
my  pupilage,  before  I  went  abroad,  and  I  thought 
I  had  never  seen  one  so  sick  as  he  was,  who  re- 
covered. Thus,  at  the  first,  I  was  in  despair. 
But,  on  the  second  day,  when  I  had  reviewed  the 
case,  my  feelings  changed.  I  began  to  have  hope, 
and  happily  my  hopes  became  stronger  from  day 
to  day,  or  at  least,  from  week  to  week,  and  in  a 
month  or  less,  I  regarded  his  ultimate  recovery  as 
almost  certain.  When  I  entered  on  a  considera- 
tion of  the  case,  with  a  view  to  treatment,  I  put  on 
paper  the  opinions  I  had  adopted  as  to  the  actual 
pathological  state  of  the  patient,  the  changes  which 
I  should  strive  to  produce  by  the  treatment,  and 
the  means  best  adapted  to  bring  about  these 
changes.  From  the  relation  of  the  patient  to 
myself,  my  strong  interest  in  him,  and  the  great 
responsibility  I  felt  to  the  parents,  who  ventured 
to  intrust  their  only  child  to  the  care  of  a  strip- 
ling like  myself,  the  circumstances  have  remained 
in  my  mind  to  this  period,  more  than  sixty 
years,  since  they  occurred.     I  shall  not,  however, 


NOTES.  09 

give  all  the  details  of  the  case,  though   I    :eni 
relate  so  much  as  to  make  it  intelligible.      ted. 

I  must  EO  back  to  show  how  this  child  had  tfJit 
brought  to  the  dismal  state,  in  wliich  I  found  him. 
He  was  small  at  his  birth,  which  was  premature 
by  more  than  two  months.  Under  the  care  of  an 
experienced  nurse,  he  got  on  very  well  during  the 
summer  and  autumn  of  1799.  Unhappily,  his 
mother's  strength  and  health  failed  her,  so  that  he 
was  weaned  in  the  spring  of  1800.  From  that 
time  till  the  next  October,  when  I  saw  him,  he 
was  at  the  height  of  his  teething.  During  this 
period,  he  should  have  been  fed  partly,  if  not 
wholly,  on  the  human  milk.  Cholera  mfantum  was 
brought  about,  and  became  severe  from  the  den- 
tition, the  dogday- weather,  and  the  unpropitious 
diet. 

I  will  not  here  go  into  an  explanation  of  the 
pathological  state  in  Cholera  infantum^  which  I 
have  endeavored  to  describe  in  the  ninth  of  these 
letters.  At  the  time,  when  I  took  charge  of  this 
child,  I  had  not  as  definite  opinions  on  the  subject 
as  I  acquired  subsequently.  I  then,  however, 
saw,  how  all  the  evils  were  aggravated  by  the  foul 
and  acrid  contents  of  the  alimentary  canal,  and 
from  time  to  time  procured  relief  by  a  small  dose 


^^'*'  NOTES. 


^®)  Klomel,  sometimes,  though  rarely,  followed  by 
earlier  oil,  or  some  like  article.  I  believe  that 
^^  ^^  net  relief,  for  the  time  at  least,  followed  every 
dose  of  calomel.  But,  from  the  first,  my  great 
object  was  to  prevent  the  recurrence  of  this  foul 
state  of  the  canal,  by  limiting  the  quantity  of  food 
and  drink,  and  by  administering  such  as  could  be 
best  digested,  or  such  as,  if  not  digested,  would 
be  the  least  likely  to  cause  morbid  imtation  by 
becoming  acid,  or  acrid.  I  directed  a  bath,  pleas- 
antly tepid,  at  night,  to  soothe  the  whole  system, 
to  equalize  the  temperature,  and  thus  to  promote 
sleep.  In  the  morning,  the  cold  sponge  bath,  to 
which  the  child  had  been  accustomed  from  his 
birth,  and  which  seemed  grateful  to  him,  was  con- 
tinued. He  was  too  feeble  to  walk,  but  he  was 
carried  abroad  every  day,  when  the  weather  was 
not  positively  foul.  He  enjoyed  this  excursion, 
and  it  was  continued  through  the  winter,  as  the 
best  thing  next  to  food,  to  restore  his  health. 

His  food  was  boiled  milk,  to  which  was  added 
lime  water,  when  the  dejections  were  loose  and 
frequent,  the  cold  water  cracker  soaked  in  water, 
when  he  wished  it,  and  tender  beef  or  mutton, 
broiled  or  roasted,  twice  a  day  if  he  liked  them, 
with  poultry  occasionally,  by  way  of  variety  ;  for 


NOTKS.  l09 

regard  was  had  to  his  taste,  so  far  as  consistem 
with  the  principles,  on  which  his  food  was  selected. 
These  principles  were  to  avoid  acid  and  acescent 
articles,  and,  as  far  as  could  be,  consistently  with 
his  taste,  to  avoid  food  in  a  liquid  form.  I  doubt 
not  that  some  tonics  and  cordials,  such  as  wine, 
were  administered  with  this  food ;  but  my  memory- 
does  not  serve  me  on  that  point.  It  is  the  at- 
tention I  gave,  when  commencing  practice,  to 
hygienic  principles,  which  it  is  my  special  object 
to  state.  I  may  say  that,  from  that  day  to  this,  I 
have  studied  those  principles,  and  endeavored  to 
guide  my  patients  by  them.  I  will  remark  that 
this  is  not  always  easy.  With  some  patients  there 
are  prejudices  to  be  overcome  ;  some  are  not 
willing  to  submit  to  the  self-denial  as  to  various 
indulgences,  especially  as  to  the  quantity  and 
quality  of  food ;  and  some  are  unwilling  to  make 
the  efforts  required.  In  the  case  I  have  related, 
I  had  friends  willing  to  pursue  the  treatment  I 
directed  in  the  most  thorough  manner. 

I  have  said  that,  when  I  first  looked  on  my 
nephew  under  his  disease,  he  seemed  so  exhausted, 
and  so  wretchedly  feeble,  that  I  felt  as  if  he  could 
never  live  to  have  comfortable  health,  and  that 
he  could  never  become  useful  to  himself  or  others. 


104*8  NOTES. 

mA  fortnight  later,  when  he  had  become  convales- 
e.'  cent,  I  ventured  to  give  an  encouraging  prognosis. 
a^Some  wise  old  people  thought  me  wrong,  and  one 
of  them,  who  felt  a  very  strong  interest  in  my 
professional  success,  very  kindly  took  me  aside  to 
give  me  some  cautions.  He  told  me  that  he  had 
heard  of  the  hopes  I  had  given  to  the  friends  in 
regard  to  this  child,  and  that  I  had  done  hkewise 
in  respect  to  a  young  lady  of  his  acquaintance. 
"Now,"  said  he,  "everybody  says  that  both  of 
them  will  die,  and  if  you  are  so  bold  in  your 
opinions,  your  reputation  will  be  injured."  My 
reply  probably  was,  such  as  I  have  often  made 
since,  if  I  did  not  then ;  —  that  I  thought  it  no 
more  than  fair  to  impart  to  the  friends  the  hopes 
which  I  felt  authorized  to  entertain  myself.  Sure- 
ly I  would  not  promise  a  recovery  in  a  doubtful 
case,  but  I  would  not  allow  loving  friends  to  suffer 
more  than  was  needful.  Happily,  the  young  lady 
above  referred  to  recovered,  and  is  now  living, 
having  given  and  received  much  pleasure  during 
the  sixty  years  which  have  since  passed  away. 
My  httle  nephew  also  recovered,  and,  at  the  end 
of  two  or  three  years,  he  became  tolerably  vigor- 
ous. Ultimately  he  became  a  tall  and  healthy 
man. 


NOTES.  109 

It  is  not  for  us  to  judge  what  a  miserable  sickly 
infant  may  become,  if  he  can  be  can'ied  over  a 
few  weeks.  This  feeble  boy  was  John  Lowell, 
the  founder  of  the  Lowell  lectures.  He  lived 
to  be  father  of  two  children,  both  of  whom  died 
within  three  weeks  of  each  other  of  scarlet  fever, 
which  prevailed  at  the  time  under  one  of  its  most 
pestilential  forms.  Their  mother  had  gone  before 
them.  Mr.  Lowell  was  then  left,  a  little  more 
than  thirty  years  of  age,  a  widower  and  childless. 
At  the  end  of  two  years  he  followed  an  inclination 
he  had  felt  in  early  life,  and  engaged  in  travels  in 
foreign  countries.  After  a  visit  in  Europe,  where 
he  had  been  once  before,  he  went  to  Egypt,  and 
there  passed  some  time,  during  which  he  con- 
tracted a  disease  of  the  climate.  He  did  not  give 
up  his  projects,  but,  passing  over  the  desert,  went 
to  the  Gulf  of  Persia,  and  thence  to  Bombay. 
He  reached  that  place  in  miserable  health,  and 
within  a  few  weeks  his  life  was  terminated,  in 
the  thirty-seventh  year  of  his  age. 

Mr.  Lowell  died  possessed  of  a  large  fortune. 
One  half  of  this  property  he  gave  by  his  will  to 
establish  the  Lowell  Institute.  The  custom  of 
having  popular  lectures  had  begun  not  long  before 
his   departure   from   his   native   shores.     He  saw 


110  NOTES. 

that  much  good  might  be  done  by  such  lectures, 
if  conducted  discreetly  on  a  liberal  plan,  such  as 
would  bring  forward  men  of  the  best  talents.  It 
was  principally  for  such  lectures,  and  entirely  for 
giving  popular  instruction,  that  this  Institute  Avas 
established.  The  inhabitants  of  Boston  well  know 
how  much  pleasure  and  profit  have  been  derived 
directly  from  these  Lowell  Lectures  for  the  last 
twenty  years,  and  as  yet  we  may  say  they  have 
only  made  a  beginning.  We  may  hope  that  this 
blessing  to  our  community  may  continue  for  many 
ages.  But  this  is  not  all.  One  good  thing  leads 
to  another.  Distinguished  men  have  been  brought 
from  Europe  to  give  courses  of  lectures  in  this 
Institute.  It  is  in  this  way  Mr.  Agassiz  was  in- 
duced to  visit  our  country.  How  much  this  most 
distinguished  naturalist  has  already  done,  and  how 
much  directly  or  indirectly  he  will  do  for  us,  I 
will  not  undertake  to  tell.  If  our  wealthy  men 
do  not  become  less  mindful  of  the  interests  of 
science  than  they  have  hitherto  been,  our  Uni- 
versity at  Cambridge  may  have  a  School  for 
Comparative  Zoology  such  as  the  world  has 
hitherto  never  possessed. 


NOTE   II. 

*'  (America),  January  30th,  1846. 

"  I  THANK  you  much  for  having  written  the 
article.  The  fulness  of  time  has  come  in  which 
all  this  matter  should  be  exposed  fully  and  clearly. 
You  have  not  said  a  tiling,  which  I  have  not 
thought  of  and  agreed  to  beforehand.  I  know 
how  presumptuous  this  may  seem  ;  but  you  know 
that  it  is  one  thing  to  entertain  correct  thoughts 
on  a  subject,  and  quite  another  thing  to  bring 
them  out  clearly  and  in  proper  order,  so  as  to 
claim  the  assent  of  all  good  judges.  This  last  is 
what  you  have  done  most  satisfactorily. 

"  Some  of  the  opinions  you  have   expressed   I 

have    entertained  for  many  long  years  ;  others  I 

have  arrived  at  more  lately.     I  first  longed  for  a 

good  natural  history  of  diseases,  to  decide  how  far 

remedies  had  an  effect.     As  connected  with  this  I 

early  learned  the  primary  importance  of  diagnosis, 

and  this   in    reference   to   the  different  stages  of 

diseases,  as  well  as  in  reference  to  diseases  them- 

[111] 


112  NOTES. 

selves.  It  is  many  years  since  I  was  satisfied,  in 
respect  to  acute  diseases,  that  it  was  only  on  the 
first  days  (principally  the  first  three  days)  that 
medicine  (drugs)  could  be  of  much  service.  At 
this  period  I  am  still  satisfied  that  acute  diseases 
can,  ordinarily,  be  much  mitigated  and  somewhat 
shortened.  But  an  exception  must  be  made  in 
regard  to  such  as  we  call  malignant  (yellow  fever, 
Asiatic  cholera);  and,  as  to  shortening,  in  re- 
ference to  the  exanthemata.  I  have  been  getting 
more  and  more  of  the  opinion,  that  in  most 
chronic  diseases,  diet  and  regimen  will  often  have  a 
great  influence, —  drugs  rarely  have  any  very  de- 
cisive good  effect,  and  often  an  injurious  effect 
only.  I  have  long  deprecated  the  idea  (and  this  I 
have  done  in  communication  with  my  intelligent 
patients)  that  medicines  (drugs)  are  necessary  in 
the  treatment  of  all  diseases.  I  have  urged  that 
it  was  the  business  of  the  physician  to  take  care  of 
the  sick,  pointing  out  that  cure  and  care  were  the 
same  word  originally,  —  and  that  in  taking  care, 
it  was  much  more  important  that  he  should 
endeavor  to  control  the  influence  of  the  common 
agents,  than  that  of  the  occasional  ones,  called 
medicines ;  —  that  he  should  attend  to  the  non- 
naturals,  —  those   things  which   nature   does   not 


NOTES.  113 

decide,  but  leaves  to  our  choice,  —  that  he,  the 
physician,  should  do  it,  and  not  leave  it  to  the 
nurse  or  the  grandmother.  In  consonance  with 
these  views,  I  have  been  unwilling  to  say  that  my 
patients,  who  recovered,  were  cured  by  me ;  for  I 
endeavored  to  cure  all  of  them,  and  claimed  to  have 
done  it,  even  when  they  died.  In  our  hospital, 
opened  twenty  odd  years  ago,  I  would  not  allow 
the  record  books  to  say  that  so  many  patients  had 
been  cui'ed,  as  is  a  common  practice  ;  but  that  so 
many  were  discharged  w^ell,  so  many  improved  in 
health,  &c.  I  have  often  urged  upon  my  brethren 
that  we  should  never  get  the  better  of  quackeiy, 
so  long  as  we  attributed  the  recovery  of  our 
patients  to  medicine,  on  the  propter  hoc  principle, 
—  that  is,  propter  hoe  because  post  hoc.  Our 
proper  ground  is,  that,  having  studied  the  subject 
and  had  personal  experience,  we  know  better  than 
others  how  to  direct  the  cure  of  the  sick  ;  and 
that  in  doing  so  we  may  use  drugs,  or  may  not,  as 
the  case  may  require.  These  drugs  may  some- 
times be  directed  against  the  principal  disease  ; 
but  oftener,  they  may  be  used  to  counteract  or 
guard  against  the  accidents,  which  would  aggra- 
vate that  disease. 

"  I  have  found  no  difficulty  in  all  this.     In  some 
10 


114  NOTES. 

respects  I  have,  perhaps,  had  advantages  which 
you  do  not  yet  enjoy.  .  .  Though  we  have  good 
apothecaries,  by  whom  alone  medicines  are  or- 
dinarily put  up,  —  they  are  strictly  men  of  the 
shop.  They  never  visit  the  sick,  and  do  not 
pretend  to  practice.  They  make  their  charges 
for  medicines  alone,  and  are  paid  as  grocers  or 
other  tradespeople  are.  The  physicians  (and 
practitioners  generally)  charge  for  their  services, 
whether  they  order  medicine  or  not.  Thus,  there 
are  none  of  the  inducements  to  employ  drugs, 
which  exist  among  a  large  class  of  practitioners 
with  you.  In  our  country  towns  the  physicians 
supply  the  drugs ;  still  the  influence  of  city 
customs  prevents  their  resting  their  emoluments 
on  these  ;  they  charge  distinctly  and  mainly  for 
their  visits,  &c.  Again,  among  the  regular 
practitioners  we  have  not  any  distinction  of 
classes ;  though  age,  &c.  give  to  some  men  ii 
certain  rank,  it  is  very  different  from  what  exists 
with  you.     We  all  of  us  have  therefore  a  chance 

to  get  patients  at  the  onset  of  disease 

''  I  have  said  that  I  have  found  no  difficulty  in 
satisfying  patients  without  medicines.  I  began 
life  with  a  good  confidence  in  certain  articles,  and 
more   especially  in   the  alterative   powers   of  mer- 


NOTES.  115 

curials.  The  doctrine  now  prevalent  with  you  as 
to  the  power  of  calomel  in  acute  diseases,  especial- 
ly in  inflammation,  was  familiar  to  me,  and  fully 
beheved,  when  I  attended  St.  Thomas's,  in  1799- 
1800.  I  used  to  say  to  my  young  friends  there, 
with  the  true  juvenile  conviction  of  superiority, 
that  it  was  singular  Dr.  Saunders  (William)  could 
be  so  bhnd  ;  in  his  book,  and  in  his  lectures,  he 
advised  the  use  of  mercuiy  in  acute,  as  well  as  in 
chronic  hepatitis  ;  yet  did  not  see  that  it  ought  to 
be  equally  useful  in  other  acute  inflammations,  as 
I  knew  that  it  was.  It  was  some  years  later  that 
one  of  your  Dr.  Hamiltons  (in  England,  not 
Scotland)  first  brought  forward  the  general 
doctrine ;  at  least,  so  far  as  I  know.  At  the 
present  day,  I  find  it  maintained  by  Dr.  Watson 
in  his  delightful  lectures.  Now,  I  am  not  ready 
to  say  that  the  practice  is  all  wrong.  There  is 
perhaps  some  good  in  it  in  some  cases  ;  but  when 
pursued  heroically  it  does  a  wonderful  deal  of 
mischief.  Whether  it  often  causes  a  fatal  result  I 
will  not  say  ;  I  think  not  often  ;  but  it  often  adds 
much  to  the  suffering  of  the  patient  and  to  the 
duration  of  his  sickness,  if  not  of  his  disease.  I 
began  to  perceive  this  early  in  my  career,  but  not 
in    its    whole    extent   for   more    than   twenty-five 


116  NOTES. 

years.  In  acute  rheumatism  I  gave  up  the 
mercurials  within  six  or  eight  years  after  I  began  ; 
.though  it  would  seem  to  be  the  disease,  to  which  it 
should  be  most  applicable.  And,  as  early  as,  this 
I  became  veiy  careful  not  to  produce  a  bad  sore 
mouth  in  any  case  of  disease.  But  I  was  a  pio- 
neer here ;  and  I  can  boast  (for  I  may  seem  to  be 
boasting)  much  more  of  what  has  been  done  by 
younger  men  —  whose  modes  of  philosophizing  in 
medicine   I  have  influenced  in  some   measure  — 

than  of  my  own  doings 

"  I  must  finish  by  saying,  that  I  am  often  con- 
sulted by  people  from  the  countiy,  as  well  as  from 
the  city,  in  chronic  diseases,  thouo-h  I  have  ceased 
to  be  a  bwsy  practitioner  ;  and  that  I  find  no 
difficulty  in  satisfying  a  patient,  after  an  hour's 
lecture  upon  his  mode  of  life  and  conversation, 
without  any  prescription  for  medicine.  In  epilepsy 
and  in  phthisis,  except  so  far  as  symptoms  may 
require  to  be  alleviated,  I  always  tell  the  patient 
at  once  not  to  employ  any  dnig  to  remove  his 
disease.  But  in  epilepsy,  not  evidently  from 
organic  disease,  and  in  phthisis  at  an  early  period, 
I  venture  to  say  that  much  alleviation  and  benefit 
may  be  derived  from  care  as  to  diet,  exercise 
abroad,  &c.     Do  not  understand  that  there  is  a 


NOTES.  117 


precise  formula,  which  I  follow  in  these  cases.  I 
try  to  communicate  principles  rather  than  rules, 
and  I  find  a  large  proportion  of  patients  can  un- 
derstand me." 


NOTE    III. 

Among  the  sciences,  the  principles  of  which  it  is 
necessaiy  for  the  pliysician  to  understand,  is  that 
of  human  nature ;  or,  otherwise  described,  the 
principles  of  the  philosophy  of  the  human  mind 
and  heart.  This,  strictly  and  properly,  is  a  branch 
of  human  physiology.  It  is  not,  however,  a  branch 
which  is  ordinarily  brought  into  view,  if  it  is 
ever  thought  of,  by  our  teachers  of  physiology. 
The  mind  has  so  much  to  do  with  the  health  of 
the  body,  the  two  mutually  acting  on  each  other, 
that  an  intimate  acquaintance  with  the  one  is 
necessary  to  a  full  comprehension  of  the  other. 
A  person  who  is  familiar  with  the  characteristics 
of  the  mind  and  heart,  is  prepared  to  see  how 
the  bodily  health  is  injured  and  how  it  is  benefited 
through  the  medium  of  the  mind.  These  obvious 
truths  are  familiar  to  medical  and  non-medical 
men,  whether  they  are  adverted  to  as  nuich  as 
they  should  be,  or  not.  But  I  wish  now  to  bring 
into  view  the  importance   of  a  knowledge  of  the 

1118] 


NOTES.  119 

human  mind  and  heart  with  reference  to  one 
branch  of  the  details  of  a  physician's  daily  duties, 
which  is  not  perhaps  sufficiently  regarded.  It  is 
a  daily  business  of  a  physician,  an  hourly  duty,  to 
ascertain,  through  human  testimony,  what  has  oc- 
curred to  his  patients.  As  far  as  possible,  let  the 
physician  get  a  knowledge  of  the  case  before  him 
by  the  objective  signs.  Some  of  our  brethren 
rely  on  these  alone,  and  scarcely  ask  a  question  as 
to  the  history  of  a  case  presented  to  them,  though 
they  may  listen  to  the  story  told  by  the  patient 
or  his  friends.  Now  I  hold  that  it  is  wise  to  get 
all  the  information  we  can,  by  our  own  senses,  — 
to  learn  in  that  way  all  the  objective  signs  of 
health  or  disease.  For  we  may  be  able  to  get 
an  absolute  assurance  about  these,  while  there  is 
some  difficulty  in  gaining  a  certain  knowledge  of 
the  subjective  signs.  Yet,  ordinarily,  it  is  highly 
important  that  we  should  gain  this  knowledge,  and 
most  of  us  always  seek  it.  Remember  that  we 
must  depend  upon  the  patient  for  an  account  of 
tliese  signs,  and  there  are  various  modes,  in  which 
we  may  be  deceived  about  them.  In  some  in- 
stances, strange  to  say,  the  patient  deceives  us 
designedly,  influenced  by  various  motives.  But 
more  frequently  he  misleads  us  undesignedly.    This 


120  Ts'OTES. 

happens  from  an  imperfect  observation  of  himself, 
from  forgetfuhiess,  or  carelessness  in  his  answers 
to  questions,  or  very  often  from  a  want  of 
accuracy  in  the  use  of  language.  Thus  you  may 
ask  your  patient  if  he  suffers  any  pain,  and  he 
may  answer,  no,  none  at  all  ;  yet  a  few  minutes 
afterwards  you  may  gather  from  him  that  he 
often  has  a  headache,  or  that  in  the  night  he  is 
frequently  annoyed  by  cramps  in  his  lower  ex- 
tremities, or  that  when  he  coughs  he  feels  a  pain 
in  his  breast,  or  side,  —  or  that  some  pain  is  in- 
duced when  he  lies  down  in  bed.  Even  thought- 
ful and  careful  people  wall  sometimes  assert  a 
universal  negative,  without  being  aware  of  its 
force.  We  must  then  cross-question  our  patients, 
and  their  friends,  who  assist  them  in  reporting 
their  histories.  It  is  the  proper  duty  of  a 
nurse  —  (the  person  who  takes  care  of  the  sick 
is  to  be  called  the  nurse,  w^hether  a  friend,  or  a 
hireling)  —  it  is  the  proper  duty  of  the  nurse  to 
report  to  the  physician,  at  every  one  of  his  visits, 
wdiatever  has  occun*ed  during  his  absence,  in  the 
order  of  the  occurrences.  A  woman  who  can 
take  very  good  care  of  the  sick  man,  may  be 
quite  unable  to  make  a  good  report  from  a  want 
of  the  habit  of  close  observation,  or  from  a  want 


NOTES.  121 

of  the  knowledge  of  language.  But,  besides, 
when  a  nurse  is  closely  questioned,  she  often 
answers  wrong  by  design.  She  may  think  that 
she  ought  to  be  able  to  give  an  answer,  when,  in 
reality,  she  is'  not ;  and  then  she  will  give  some 
answer,  relying  on  a  guess  to  hide  her  ignorance. 
Or,  she  may  fear  that  an  evil,  which  has  occurred, 
such  as  a  chill,  may  be  attributed  to  her  negli- 
gence, and  for  that  reason  she  will  try  to  keep  it 
from  the  knowledge  of  the  Doctor  ;  or  she  may 
have  committed  an  error  in  the  food,  or  the 
medicine,  and  be  afraid  to  acknowledge  it.  It 
requires  some  address  to  ascertain  the  truth,  and 
guard  against  error  from  these  sources.  It  be- 
hoves the  physician  always  to  pursue  his  in- 
quiries calmly,  not  using  words  or  tones  which 
will  agitate  the  patient,  or  the  nurse,  from  appre- 
hension that  he  will  find  fault.  And,  generally, 
it  is  unwise  in  him  to  reproach  the  nurse  when 
she  has  made  a  mistake.  If  he  do  this,  she  may 
be  unwilling  to  tell  him  the  truth  another  time. 
If  the  nurse  is  too  negligent,  or  grossly  deficient 
in  her  duty,  he  may  take  measures  to  have  her 
discharged.  But,  however  it  may  seem  to  show 
his  spirit,  it  does  not  belong  to  him  to  find  fault 
with  her.  Let  him  point  out  the  faults  to  her 
11 


122  NOTES. 

employers  when  they  are  too  great.  For  the 
sake  of  the  patient,  it  is  important  to  avoid  un- 
pleasant discussions  in  the  sick  room. 

I  hope  these  remarks  will  not  be  thought  too 
trivial. 

I  am  tempted  to  take  this  occasion  to  put  in 
print  a  statement  of  the  merits  of  a  nurse  in  the 
Massachusetts  General  Hospital,  who  began  her 
career  there  a  few  years  after  it  was  opened,  and 
after  a  service  of  thirty-four  years,  left  that  ex- 
cellent institution  a  few  months  since.  Trustees 
and  medical  men,  who  have  been  familiar  with 
the  Hospital,  will  understand  at  once  that  I  have 
reference  to  Miss  Rebecca  Taylor.  I  believe  that 
there  is  not  any  person  living,  who  has  been 
connected  with  the  hospital  for  so  many  years,  — 
perhaps  I  may  say  for  half  as  many  years,  as  she 
was.  If  any  person  is  to  be  excepted,  it  is  my- 
self. From  the  day  on  which  the  house  was 
opened  to  this  day,  about  forty  years,  I  have 
been  nominally  connected  with  it ;  and,  so  far  as 
a  strong  interest  in  it  is  concerned,  I  have  been 
connected  with  it  from  the  first  conception  of  its 
establishment.  But  my  active  ser\'ice  in  it  ex- 
tended only  through  its  first  fifteen  years.  Since 
then,  for   about    twenty-five  years,  I    have   ])cen 


NOTES.  123 

only  a  consulting  physician.  But  my  excellent 
friend,  Miss  Taylor,  gave  her  personal  services, 
Avith  occasional  visits  to  the  country  for  health's 
sake,  for  the  whole  period  of  thirty-four  years ; 
and  this  in  the  office  of  head  nurse,  doing  all  its 
duties  till  a  few  of  the  last  years  of  her  service. 
It  is  certain  that  she  would  not  have  been  re- 
tained in  office  so  long,  if  she  had  not  merited 
some  distinction.  All,  who  have  known  her, 
will  remember  the  great  modesty  of  her  deport- 
ment. She  never  obtruded  herself  on  the  notice 
of  any  one,  and  never  claimed  any  distinction. 
It  has  long  been  my  remark  that  physicians  and 
nurses  might  be  divided  into  two  classes ;  viz : 
those  who  keep  in  view  their  own  glory,  and 
those  who  look  only  to  the  welfare  of  the  patients 
under  their  care.  Miss  Taylor  Avas  of  the  last 
class.  With  most  of  us  there  is  experienced  a 
regard  to  both  the  considerations  above  mentioned. 
With  her  I  never  saw  that  she  thought  at  all  of 
her  own  glory.  She  was  uniformly  devoted  to  the 
sick  in  her  wards,  in  the  most  quiet  manner,  and 
most  tenderly  too  ;  but  she  never  substituted 
terms  of  endearment  for  faithfid  and  punctual 
attendance.  I  remember  that  she  committed  mis- 
takes  in   administerinoj   medicines   twice.       Both 


124  NOTES. 

times,  wlien  I  inquired  into  the  circumstances, 
she  told  me  at  once,  in  a  distinct  voice,  "  It  was 
my  fault,  sir."  She  would  have  been  unhappy, 
if  she  could  not  have  made  the  avowal  of  her 
eiTors.  I  do  not  doubt  that  she  might  have 
explained  them  away,  but  she  would  not  attempt 
to  do  it.  There  were  two  instances,  under  my 
observation,  in  which  she  had  reason  to  think 
ill  of  the  characters  of  patients  in  her  wards. 
She  did  her  duty  towards  them  ;  but  it  was  with 
a  coldness,  which  she  seemed  unable  to  repress. 
In  proportion  as  her  patients  were  helpless,  her 
attentions  to  them  were  more  assiduous.  I  must 
indulge  myself  in  giving  one  instance ;  the  reader 
may  pass  it  over,  if  he  pleases. 

Many  years  ago  there  was  placed  in  Miss  Tay- 
lor's ward  a  very  respectable  Dutch  woman,  who 
had  recently  arrived  in  this  country,  and  could 
not  speak  a  word  of  English.  She  was  past  fifty 
years  of  age,  with  a  smooth  and  fair  countenance, 
and  one  expressive  of  kindness  and  gentleness. 
Her  good  looks  might  have  influenced  anybody, 
and  no  doubt  might  have  had  some  effect  on  our 
f^ood  nurse.  As  none  of  us  could  speak  in  the 
Dutch  tongue,  we  obtained  help  from  tAvo  learned 
Germans  ;  but,  after  four  or  five  days,  we  were 


NOTES.  125 

able  to  relieve  them  from  further  attendance.  At 
that  time,  Miss  Taylor  had  established  a  language 
of  signs  with  the  patient,  and  watched  her  so 
closely,  that  she  was  able  to  give  us  a  very  satis- 
factory account  of  the  case  from  day  to  day,  and 
with  her  intervention  the  management  of  the  case 
was  so  successful,  that  the  patient  was  dismissed 
well  after  a  week  or  two.  Meanwhile  our  Dutch 
woman  learned  to  speak  two  words  of  imperfect 
EngHsh,  which  she  repeated  daily,  pointing  to  our 
Miss  Taylor.  These  words  were  "  too  goot,  — 
too  goot." 

I  will  add,  that  I  reminded  Miss  Taylor  of  this 
case  lately,  when  I  called  to  see  her  before  she 
left  the  hospital.  She  remembered  it,  and  told 
me  that  in  other  instances  she  had  not  found  it 
difficult  to  maintain  a  satisfactory  intercourse  with 
patients,  who  could  not  speak  our  language.  It  is 
obvious  that  this  could  not  happen  without  the 
most  devoted  attention  on  the  part  of  the  nurse. 

There  is  not  any  comparison  to  be  made  be- 
tween our  good  nurse  and  Miss  Nightingale.  The 
latter  is  a  lady  of  education,  and  in  a  different 
rank  in  life.  She  sees  how  important  is  the  office 
of  a  nurse.  She  has  studied  the  duties,  I  may 
say  the  high  duties  of  a  nurse  for  the  sick.     She 


126  NOTES. 

lias  broiiglit  science  to  her  aid,  and  she  has  the 
energy  to  teach  the  operatives  the  way  to  do  then- 
work,  and  the  care  and  fidelity  requisite  to  do  it 
effectually.  I  have  no  doubt  she  has  set  examples 
to  her  pupils  in  the  hospitals,  in  which  she  has 
taken  the  oversight  of  the  patients.  It  is  evident 
from  her  writings  that  she  has  not  been  a  mere 
looker-on.  My  friend  is  one  of  much  humbler 
pretensions.  She  has  been  a  hired  nurse.  She 
sought  an  employment  for  her  living.  Having 
gained  an  appointment,  she  gave  herself  to  her 
duties.  Filled  with  a  sense  of  duty,  she  brought 
all  her  faculties  into  exercise,  without  bustle,  and 
without  parade.  She  did  not  think  of  reputation, 
of  gaining  a  character.  She  must  have  had  system 
and  industry,  for  I  always  found  her  work  was 
done  in  proper  season.  Her  fidelity,  her  tenderness- 
her  patience,  were  proved  by  the  uniform  satis- 
faction shown  by  the  sick  under  her  care.  One, 
who  saw  her  casually,  might  think  her  cold.  Her 
manners  were  always  calm.  She  was  never  in  a 
hurry ;  rarely,  if  ever,  agitated.  But  the  strength 
and  warmth  of  her  feelings  were  shown  by  the 
constancy  and  tenderness,  with  which  she  per- 
formed the  trying  duties  of  her  office ;  hence 
the  confidence  which  was  placed  in  her  by  her 
patients. 


NOTES. 


Miss  Taylor  is  a  small  woman,  but  well  propor- 
tioned. She  is  not  slender,  and  never  showed 
weakness,  though  not  fitted  for  hard  and  heavy 
labor.  She  is  well  formed  ;  but  the  contour  is  de- 
rived entirely  from  the  muscles,  while  there  is 
none  of  the  rotundity  caused  by  adipose  matter 
near  the  surface.  Her  face  is  thin,  the  features 
well  defined,  her  nose  and  chin  distinctly  promi- 
nent, her  eyes  blue,  decidedly  handsome,  and, 
with  her  mouth,  full  of  expression.  Every- 
thing about  her  shows  calmness  and  composure  of 
mind.  She  uses  few  words,  but  they  are  apposite, 
very  definite,  and  are  uttered  distinctly.  Though 
she  never  shows  any  violence  in  her  manners,  she 
manifests,  at  all  times,  so  much  firmness  that,  as  I 
suspect,  she  has  rarely  met  with  any  resistance 
from  those  under  her  control.  I  never  heard  that 
any  one  complained  of  her.  She  seldom  found 
fault  with  others.  I  think  if  any  unhappy  and 
captious  individual  in  her  ward  had  found  fault 
with  her,  all  the  other  inmates  of  it  would,  at 
once,  have  risen  up  in  her  defence.  At  one  time 
a  very  excellent  and  intelligent  woman,  whom  I 
had  recommended  for  some  years  as  a  private,  or 
family  nurse,  became  very  sick,  and  was  brought 
to  our  hospital  in  a  dreadful  and  helpless  state. 


128  NOTES. 

She  was  palsied,  and  had  extensive  bedsores  at 
the  time  of  her  admission,  so  as  to  be  very  offen- 
sive. She  retained  her  mental  faculties,  and  was 
well  qualified  to  criticize  a  nurse.  "  Oh,  sir," 
she  would  exclaim  to  me,  "you  don't  know, — 
nobody  knows,  —  what  an  excellent  nurse  and 
what  an  excellent  woman  Becky  Taylor  is !  " 

But  I  will  stop.  I  have  always  known  how 
difficult  the  duty  of  a  nurse  is ;  how  much  it  re- 
quires to  make  a  good  one.  It  has  been  my  prac- 
tice to  praise  and  encourage  every  one,  whom  I 
found  capable  of  doing  Avell.  I  have  known  many 
good  ones  in  private  families.  It  is  harder  to  per- 
form well  and  faithfully  the  nursing  in  a  hospital. 
I  have  been  describing  one  the  most  uniformly 
faithful,  fulfilling  all  her  duties  in  the  most  fault- 
less manner.  I  have  loved  many  others,  but  I 
have  loved  her  the  most.  I  avail  myself  gladly 
of  an  opportunity  to  leave  behind  me  this  testi- 
mony to  her  merits.  Her  best  reward  is  in  her 
own  breast.  She  must  know  that  she  tried  to  do 
her  whole  duty.  It  is  for  others  to  say  how  well 
she  succeeded.  It  may  gratify  her,  in  her  retire- 
ment, to  read  what  I  have  written.  I  am  happy 
to  know  that  she  reciprocates  my  friendship.  But 
it  is  not  to  gratify  her  that  I  have  done  this.     It 


NOTES.  1 29 

is  a  pleasure  to  bear  testimony  in  favor  of  one  so 
good.  I  cannot  help  hoping  that  it  will  be  useful 
to  hold  up  such  an  example  for  imitation.  And, 
I  will  add,  that,  so  far  as  my  influence  can  go,  I 
wish  to  point  out  how  high  are  the  duties  of  a 
nurse  ;  and  how  justly  they  entitle  one,  who  per- 
forms them  skilfully  and  faithfully  and  kindly,  to 
the  love  and  respect  of  mankind. 


NOTE   IV. 

MIR.    FRESCOXT'S     CASE. 

My  Dear  Mr.  Ticknor, 

You  ask  for  a  statement  in  respect  to  the 
diseases,  which  affected  our  late  friend,  Mr.  Pres- 
cott.  It  would  not  be  interesting  to  relate  all  the 
ailments  of  his  life,  of  which  there  was  the  usual 
variety.  His  eyes  suffered  from  accident  at  one 
time,  and,  from  disease  at  another  ;  and  the  injury 
as  to  his  sight  had  a  great  influence  on  his  life. 
His  days  were  ended  by  an  affection  of  the 
brain. 

First,  at  an  early  age  his  eyesight  was  impaired 
in  such  a  degree,  that  one  might  have  supposed 
that  he  would  at  once  have  abandoned  books. 
Instead  of  this,  he  spent  his  days  among  them, 
and  became  a  distinguished  scholar,  and  a  distin- 
guished writer. 

In  his  boyhood  Prescott  was  healthy  and  vigo- 
rous. While  a  sophomore  in  our  University  at 
Cambridge,  there  occurred  a  veiy  peculiar  acci- 
dent, by  which  he  lost  the  sight  of  his  left  eye. 

[130] 


NOTES.  131 

Tliere  was  a  frolic  among  the  undergracluatL's,  in 
the  Comnions-liall,  after  dinner,  in  which  among 
other  things,  they  used  crusts  of  bread  as  missiles. 
One  of  these,  thrown  at  random,  but  undoubtedly 
with  great  force,  struck  Prescott  upon  the  globe 
of  the  open  eye.  If  the  person  who  threw  it  had 
stood  in  front  of  him,  his  eyes  would  have  taken 
the  alarm  as  the  cnist  approached  them,  the  lids 
would  have  closed  instantaneously,  and  then  per- 
haps the  injury  would  have  been  less  severe.  But 
it  was  not  so.  He  was  going  out  of  the  hall,  but, 
for  some  cause  turned  round  suddenly  with  his 
eyes  open,  and  the  crust,  already  on  its  way,  met 
his  eye  at  the  moment  when  he  turned.  From 
careful  inquiry  on  the  day  of  the  accident,  I  satis- 
fied myself,  that  this  was  the  mode  of  the  occur- 
rence, and  that^  with  all  the  marvellous  guards  by 
which  the  eyes  are  surrounded,  one  of  his  was  left 
exposed  to  a  severe  blow  on  its  unprotected  and 
tense  surface.  The  immediate  effects  were  very 
remarkable.  They  were  such  as  attend  a  concus- 
sion of  the  brain.  His  strength  was  immediately 
prostrated,  and  vomiting  took  place.  As  soon  as 
could  be,  he  was  brought  to  his  father's  house  in 
town,  where  I  saw  him  within  two  or  three  hours 
of  the  accident.     He  was  on  the  bed,  not  feehng 


132  NOTES. 

al)le  to  sit  up ;  his  face  was  pale  and  shrunk,  and 
his  skin  cool ;  but  his  mind  was  calm  and  clear,  so 
that  he  gave  a  distinct  account  of  the  unfortunate 
affair.  Though  the  eye  was  not  insensible  to 
light,  its  power  of  vision  was  lost.  It  did  not 
exhibit  any  external  mark  of  severe  injury,  but  it 
seemed  that  the  retina  had  been  paralyzed  by  the 
shock.  There  was,  I  think,  pain  in  the  eye  and 
in  the  whole  head.  His  pulse  was  feeble,  and  his 
temperature  rather  below  than  above  that  of  health. 
The  case  did  not  admit  of  any  active  treatment. 
He  was  kept  quiet,  and  every  precaution  taken 
aojalnst  irritation,  or  disturbance.  Within  a  few 
days,  the  system  recovered  from  the  shock,  but  the 
eye  never  underwent  any  material  change  during 
his  subsequent  life.  He  had  one  good  eye  left, 
and  all  who  knew  him,  know  that  it  was  bright 
enough  to  give  great  animation  to  his  expressive 
countenance. 

In  due  time,  he  returned  to  Cambridge,  and 
there  pursued  his  studies  through  the  usual  course. 
So  far  as  I  can  recollect,  he  did  not  experience 
any  trouble  In  his  right  eye  while  at  College,  nor 
subsequently,  though  his  whole  occupation  was 
over  his  books,  until  the  period  of  which  I  have 
next  to  speak.  His  general  health  during  this 
time  was  very  good. 


NOTES. 


133 


On  the  15th  of  January,  1815,  he  called  on  me 
with  an  inflammation  of  his  right  eye.  The  in- 
flammation was  seated  on  the  surface  (the  tunica 
conjunctiva).  He  spoke  of  some  pain  in  moving 
the  eye,  which  seemed  more  than  is  commonly 
noticed  in  simple  ophthalmia.  I  directed  a  satur- 
nine lotion,  and  some  leeches  on  the  temple. 
These  remedies  were  employed  that  evening. 
They  seemed  sufficient  for  a  recent  attack,  not 
showincr  extreme  violence  at  the  time  when  I  saw 
it ;  but  during  the  night  the  pain  in  the  eye  be- 
came very  violent,  and  the  next  morning  I  found 
the  inflammation  very  seriously  increased.  The 
tunica  conjunctiva  was  very  red,  and  greatly 
swollen,  so  as  to  exhibit  a  chemom^  the  most 
strongly  marked  which  I  ever  witnessed  before, 
or  since.  The  cornea  liad  become  opaque,  and 
the  power  of  vision  was  entirely  lost.  His  state 
gave  rise  to  the  most  serious  apprehensions.  To 
himself,  and  even  to  his  calm  and  philosophic 
father,  it  seemed  that  every  risk,  except  that  of 
life  itself,  must  be  incurred,  to  save  him  from  per- 
manent blindness.  Such  were  my  own  feelings. 
I  retain  at  this  distant  day  the  most  vivid  recol- 
lections of  my  apprehensions  and  solicitude  in 
reo-ard  to  this  vounir  man,  whom  1   had  known 


134  NOTES. 

from  his  childhood,  and  for  whom  I  entertained 
the  highest  regard. 

I  should  have  noted  that  on  the  morning  of 
January  16th,  his  pulse  was  hard  and  accelerated, 
and  his  skin  was  very  hot.  On  that  day,  I  bled 
him  freely  from  the  arm  twice,  purged  him  and 
vesicated  his  neck.  At  evening,  the  pain  had 
ceased,  but  it  returned  with  great  severity  during 
the  night.  I  called  in  consultation  my  friend  Dr. 
John  C.  Warren,  on  that  day.  For  five  days  the 
inflammation  continued  with  great  fury  ;  and  dur- 
ing this  time  he  lost  by  general  and  local  bleeding 
more  than  seven  pounds  of  blood,  was  purged 
abundantly,  was  blistered  freely,  was  kept  in  the 
dark,  and  on  the  lowest  diet ;  also  the  vessels  of 
the  conjunctiva  were  divided  twice,  with  a  view 
to  arrest  the  disease  in  the  cornea.  This  part 
mended  during  these  five  days,  but  the  aqueous 
humor  became  turbid.  On  the  sixth  day  the 
disease  was  yielding  in  all  parts,  and  on  the 
seventh  it  had  greatly  subsided.  The  cornea  and 
aqueous  humor  were  very  soon  restored  to  their 
usual  transparency ;  but  the  powers  of  vision  were 
scarcely  mended,  owing  as  we  presumed,  to  an 
affection  of  the  retina. 

Thus  flir,  nothing  had  appeared  except  an  in- 


NOTES.  135 

flammation  in  the  eye,  changing  rapidly  from  one 
tissue  to  another ;  this  inflammation  being  ex- 
tremely violent,  notwithstanding  the  most  vigorous 
treatment.  An  inflammation  so  violent,  was,  of 
course,  attended  by  strong  constitutional  symp- 
toms. I  ought  to  note  that  the  iris  escaped  the 
disease,  so  far  as  we  could  judge  in  a  dark  room 
and  with  an  opaque  cornea.  On  the  sixth  day 
of  the  disease  our  apprehensions  were  greatly 
abated ;  the  eye  was  in  every  respect  better  except 
as  to  the  vision,  and  we  promised  ourselves  an 
amendment  in  this  respect  also.  On  the  morning 
of  the  seventh  day,  also,  everything  seemed  favor- 
able ;  but  before  night.  Judge  Prescott  called  on 
me  to  announce  a  new  trouble.  He  said  that  a 
pain  had  come  in  the  right  knee,  which  was  on 
the  increase,  and  was  attended  by  some  redness 
and  swelling.  To  Mr.  Prescott's  surprise,  I  in- 
stantly replied,  that  I  was  very  happy  to  hear  it. 
Thus  far,  we  had  not  had  any  occasion  to  regard 
the  disease  as  different,  in  its  nature,  from  common 
inflammation ;  but  now  it  flashed  on  me  that  the 
inflammation  was  rheumatic. 

I  must  take  the  liberty  to  state  the  grounds,  on 
which  I  came  to  this  sudden  conclusion.  It  had 
lono;   been   known  that   in  some   cases   of  acute 


136  NOTES. 

rheumatism,  (or  rheumatic  fever,  as  it  was  most 
commonly  called,)  the  disease  was  not  hmited 
entirely  to  the  various  tissues  about  the  joints  and 
muscles,  but  that  it  likewise  affected  the  different 
tissues  of  the  heart  and  the  lungs.  But  it  was 
not  known  to  me  that  any  one  had  ever  beheved 
that  it  affected  also  the  tissues  of  the  eyes,  unless 
perhaps  the  muscles  appertaining  to  them.  I  had, 
however,  been  satisfied  that  such  an  affection  of 
the  eyes  sometimes  took  place.  I  had  seen  some 
cases,  of  which  one  was  very  clearly  marked,  in 
which  the  ophthalmia  was  rheumatic  in  its  charac- 
ter. In  acute  rheumatism  we  find  the  different 
joints,  or  different  muscles,  affected  in  succession, 
sometimes  two  or  more  parts  at  once.  Now  in 
cases,  which  had  occurred  before  that  of  our  friend, 
1  had  seen  the  same  change  of  the  Inflammation 
from  the  joints  to  one,  or  both  eyes  ;  and  again 
from  the  eyes  to  some  joint.  I  had  also  known 
the  eyes  to  be  attacked  more  than  once  during 
the  same  case,  just  as  an  elbow,  or  a  knee  may  be 
affected  more  than  once.  I  had  not  therefore  any 
doubt  that  the  eye,  as  well  as  the  heart,  was 
subject  to  rheumatic  inflammation.  I  had  not, 
however,  been  able  to  find  in  the  books  any  record 
of  similar  observations.     Let  it  here  be  noted  that 


NOTES.  137 

I  refer  to  acute  rheumatism.  An  affection  of  the 
eye  in  chronic  rheumatism,  especially  of  the  tunica 
sclerotica^  had  been  observed  by  different  persons. 
The  observations  on  this  affection  were  scattered, 
and  were  not,  I  believe,  at  all  familiar  to  prac- 
titioners at  the  time  I  refer  to,  viz :  in  1815.  At 
the  present  day,  the  chronic  disease  has  been 
mentioned  by  many  writers ;  though  I  doubt 
whether  it  is  now  very  well  known.  I  find  also 
the  bare  recognition  of  an  affection  of  the  eye  in 
acute  rheumatism  in  Le  Dictionnaire  des  Sciences 
Medicates,  48th  volume,  page  548.  This  volume 
was  published  in  Paris  in  the  year  1820.  In 
1816,  when  I  pubhshed  my  paper,  from  which  I 
shall  give  a  quotation,  I  had  looked  in  vain  among 
all  the  medical  works  within  my  reach  for  any 
recognition  of  such  a  case.  In  the  volume  above 
mentioned  of  the  French  Dictionary,  the  affection 
of  the  eye  in  chronic  rheumatism  is  fully  discus- 
sed, while  its  occurrence  in  the  acute  disease  is 
mentioned  in  two  lines  only.  It  is  certainly  very- 
remarkable,  that,  when  I  stated  my  opinion  on 
Mr.  Prescott's  case  to  my  friend  Warren,  he  at 
once  confirmed  it  from  his  own  experience.  He 
related  the  instances,  in  which  he  had  seen  the 
same  thing,  giving  the  names  of  the  parties,  as  I 
12 


188  NOTES. 

did  to  him  those  of  my  patients.  In  the  New 
England  Journal  of  Medicine  and  Surgery  for 
April,  1816,  both  of  us  subsequently  published 
observations  on  this  point. 

You  may  now  understand  why  I  was  rejoiced 
to  hear  from  Judge  Prescott  that  his  son's  knee 
had  become  affected  with  acute  rheumatism.  This 
was  not  because  I  regarded  rheumatic  inflamma- 
tion of  the  eyes  as  a  slight  disease,  but  because  I 
thought  it  less  likely  to  be  destructive  than  com- 
mon inflammation  of  so  severe  a  character,  as  we 
had  witnessed  in  this  instance. 

"  From  this  period  the  disease  manifested  the 
common  symptoms  of  acute  rheumatism,  affecting 
the  large  joints  of  the  lower  extremities  for  the 
most  part,  and  occasionally  the  neck  and  loins. 
It  continued  to  renew  its  attacks  with  severity  for 
three  months,  although  there  was  in  this  time  one 
interval  of  a  month,  in  which  the  disease  appeared 
to  be  subsiding.  The  eye  had  two  attacks  during 
these  three  months,  the  disease  leaving  the  limbs 
and  returning  to  them  again  as  the  eye  recovered. 
The  second  attack  was  short  but  severe,  though 
less  so  than  the  first.  The  third  was  less  severe, 
but  longer.  In  each  of  them  the  blindness  was 
perfect ;  and  in  each  the  disease  affected  first  the 


NOTES.  139 

tunica  conjunctiva,  then  the  cornea,  then  the 
aqueous  humor.  In  one  instance  the  crystalline 
humor  was  opaque  for  a  day  or  two.  The  changes 
of  structure  took  place  suddenly  and  subsided  sud- 
denly, as  happens  in  respect  to  the  swelling  of  the 
joints  in  this  disease. 

"  When  the  eye  was  attacked  the  second  time, 
blood  was  drawn  from  the  arm,  and  in  each  attack 
leeches  were  applied  liberally.  Vesication  was 
employed  almost  constantly  about  the  head  and 
on  the  limbs.  Antimonials  were  given  very  freely 
both  before  and  after  the  real  nature  of  the  disease 
was  manifested ,  —  opium  was  exhibited  p.  r.  n.  — 
and  in  the  course  of  the  disease  cinchona  was 
tried  very  fully.  The  strength  of  the  patient  was 
less  reduced  than,  might  be  expected  from  the 
evacuations  made,  and  he  was  never  so  much  pros- 
trated as  is  common  in  acute  rheumatism.  Great 
care  was  taken  in  the  use  of  both  food  and  medi- 
cine not  to  o-et  the  stomach  into  the  irritable  state 
so  common  in  this  disease;  and  although  the  appe- 
tite was  lost  in  the  early  stage,  that  organ  never 
lost  its  tone,  and  nothing  like  dyspepsia  took  place 
at  any  period. 

"  The  joints  of  the  upper  extremities  were  al- 
most  exempted   from   disease ;  but   those  of  the 


140  NOTES. 

lower  extremities  (the  knees  and  ankles)  were  so 
severely  affected,  that  the  patient  was  unable  to 
walk  a  step  from  the  first  attack  until  about  the 
1st  of  May.  During  perhaps  the  largest  part  of 
this  time  he  had  very  little  pain  when  at  rest. 

"  The  power  of  vision  in  the  rheumatic  eye  was 
never  restored  perfectly  ;  but  the  precise  state  of 
it  was  not  ascertained  until  April,  when  for  the 
first  time  the  light  was  admitted  freely  into  the 
patient's  apartment.  He  then  found  that  there 
was  frequently  occurring  an  appearance  of  some- 
thing like  the  body  of  a  spider,  with  two  wings, 
passing  over  his  eye  at  the  upper  part  of  the  pupil. 
As  there  was  not  any  mark  of  injury  in  the  cor- 
nea, nor  of  change  in  the  humors,  this  appearance 
was  attributed  to  an  affection  of  the  retina.  This 
opinion  was  confirmed  by  the  consideration  that 
the  power  of  vision  was  restored  very  slowly  after 
each  attack,  although  the  opacities  had  subsided 
suddenly  and  rapidly ;  and  by  the  statement  of 
the  patient  that  he  had  frequently  noticed  this 
appearance  before  he  mentioned  it,  and  while  the 
room  was  darkened,  but  that  he  thought  it  was 
owing  to  the  defect  of  hght  in  the  room. 

"  In  the  latter  part  of  April  and  in  May  electri- 
cal shocks  were  applied  to  the  head  three  times  a 


NOTES.  141 

day.  Also  mercurials  were  used  moderately  — 
one  grain  of  Calomel  every  night.  The  eye  re- 
covered partially,  but  not  entirely. 

"  Mr.  P.'s  mother  has  been  very  often,  and  at 
times  severely,  affected  with  rheumatism.  Two 
gentlemen,  cousins  of  hers,  have  been  nearly  crip- 
pled for  many  years  with  the  same  disease,  and 
their  eyes  have  been  so  much  affected,  as  to  have 
rendered  them  nearly  blind.  This  affection  of  the 
eyes  has  evidently  been  connected  with  the  dis- 
ease in  the  limbs." 

The  foregoing  account  is  derived  mostly  from 
the  article  referred  to  above  in  the  New  England 

o 

Journal  of  Medicine  and  Surgery,  Vol.  5th,  p. 
140,  the  latter  part  being  a  literal  copy  from  that 
article.  I  will  close  the  history  as  briefly  as  I 
can.  In  the  summer  of  1815,  Mr.  Prescott  went 
to  England,  and  afterwards  travelled  on  the  Con- 
tinent through  France,  &c.  One  of  his  objects 
was  to  consult  experienced  oculists  abroad  re- 
specting his  eyes,  with  the  hope  of  doing  some- 
thing to  help  his  vision.  At  that  time.  Sir  Wm. 
Adams  was  in  great  repute  in  London  as  an 
oculist,  in  consequence  of  having  been  veiy  suc- 
cessful in  the  treatment  of  purulent  ophthalmia. 
I  presume  that  he  was  so,  but  I   believe  that  he 


142  NOTES. 

was  not  so  well  prepared  to  meet  all  the  diseases 
of  the  eye,  as  some  of  his  cotemporaries  in  the 
English  metropolis.  Mr.  Prescott  placed  himself 
under  the  care  of  this  gentleman.  So  far  as  I 
could  discover,  he  seemed  never  to  have  entered 
into  the  question  of  the  rheumatic  character  of 
the  disease  in  the  right  eye.  He  probably  thought 
that  this  was  founded  on  a  mere  hypothesis  ; 
although  the  history  of  the  case,  fairly  viewed, 
scarcely  admitted  any  other  explanation.  Before 
Mr.  P.  left  this  country,  I  felt  assured  that  his 
case  was  not  to  be  influenced  by  any  active,  or 
heroic  treatment.  Unfortunately,  I  think.  Sir 
William  took  a  different  view  of  it,  and  kept  his 
patient  for  a  long  time  under  the  use  of  blue-pill, 
and  saline  cathartics  in  large  doses.  These  were 
employed  not  only  while  Mr.  P.  remained  in 
London,  but  subsequently  on  the  continent ;  that 
is,  for  several  months.  I  rather  think  that  this 
treatment  was  sanctioned  by  some  surgeon  in 
Paris.  However  sanctioned,  I  consider  it  certain 
that  the  eye  was  not  made  better  by  this  active 
treatment,  and  that  the  intestinal  canal  was 
materially  injured  by  it ;  so  much  so  that  his 
health,  through  his  whole  subsequent  life,  was 
permanently  affected  in  consequence  of  it. 


NOTES.  143 

I  should  not  have  written  these  lines  of  censure, 
if  this  case,  principally  on  account  of  the  celebrity 
of  its  subject,  though  partly  because  it  is  an  un- 
common one,  had  not  engaged  the  attention  of 
many  medical  men.  I  am  the  more  ready  to  go 
so  far,  because  it  opens  the  way  to  some  remarks 
on  the  treatment  I  myself  pursued  at  the  com- 
mencement of  the  attack  on  the  right  eye.  Those 
who  agree  with  me  in  my  objections  to  Sir  Wil- 
ham's  treatment,  may  say  that  mine,  at  the  time 
referred  to,  was  equally  worthy  of  censure.  Let 
me  then  recall  the  circumstances.  When  the 
disease  began,  I  had  not  any  reason  to  suspect 
that  the  inflammation  was  rheumatic.  It  is  true 
that  I  had  learned  that  the  eye  was  susceptible 
of  rheumatic  inflammation,  but  this  was  to  be 
known  only  when  it  occurred  in  connection  with 
rheumatism  in  its  common  seats,  in  the  tnmk,  or 
limbs.  I  had  never  knoAvii  the  disease  to  make 
its  first  attack  upon  the  eye.  I  may  add  that  I 
have  not  known  such  an  instance  in  the  forty- 
four  years  which  have  passed  since  that  period  ; 
nor  have  I  heard  of  any  such  having  been  seen 
by  others.  At  a  later  period  I  heard  that,  when 
young  men,  two  cousins  of  Mr.  P.  's  mother 
had  had  rheumatic  inflammation  of  the  eyes,  and 


1^4  NOTES. 

tliat  one  of  them  had  gradually  become  nearly 
blind.  But  of  these  I  had  not  heard  when  Mr. 
P.  was  sick ;  nor,  as  I  believe,  were  the  cases 
understood  at  the  time  when  they  occurred.  I 
gathered  the  histories  afterwards,  and  then  made 
the  inference  as  to  their  true  character. 

It  is  then  to  be  r^nembered  that  the  profuse 
bleeding  was  practised  on  a  young  and  healthy 
man,  wdio  had  a  most  violent  inflammation  of  his 
only  good  eye,  such  as  threatened  destruction  to 
the  delicate  tissues  of  that  organ.  This  evil  did 
not  occur,  although  the  eye  was  permanently  in- 
jured. I  am  now  fully  satisfied  that  the  treat- 
ment I  adopted  was  not  beneficial.  Possibly  it 
prevented  still  farther  mischief  to  the  eye ;  but  I 
think  it  did  not,  because  it  did  not  check  the 
disease  of  the  whole  system.  The  result  w^as 
certainly  unfavorable  to  the  treatment  of  acute 
rheumatism  by  bleeding,  a  treatment  of  which  I 
had  not  thought  favorably  before.  I  suspect  that 
there  never  was  a  case,  in  which  so  much  blood 
was  abstracted  in  the  first  five  days  of  that  dis- 
ease, as  in  this.  And  what  was  the  result  ?  The 
disease  was  greater  in  its  violence,  and  in  its 
duration,   than  it  is  in  the  average  of  cases. 

I  will  close  the  history  of  the  disease  in  the 


NOTES.  146 

right  eye  by  saying  that  it  had  diminished  so 
much  tliat  he  could  make  some  use  of  it  before 
he  went  to  Europe  in  1815  ;  although  as  a  matter 
of  precaution  he  abstained  from  any  great  use  of 
it  in  reading,  or  writing.  There  was  not  any 
opacity,  and  undoubtedly  the  permanent  difficulty 
was  mainly,  if  not  entirely,  in  the  retina.  In 
subsequent  years  he  regained  the  power  to  use  it 
in  some  measure,  but  it  always  remained  greatly 
impaired.  He  studied  very  thorouglily  and  sys- 
tematically the  influence  of  everything  operating 
on  the  organ  of  vision  and  was  very  ingenious  in 
contrivances  as  to  the  best  mode  of  using  light, 
and  of  doing  without  it.  You  will  probably  be 
led  to  mention  some  of  these  in  your  history  of 
his  life. 

From  the  time  of  Mr.  Prescott's  return  from 
his  travels  abroad,  his  pursuits  were  altogether 
literary,  and  of  course  most  of  his  time  was  passed 
in  his  library.  He  never  engaged  in  active  busi- 
ness of  any  kind.  He  was  however  very  unifonn 
in  taking  exercise  in  the  open  air,  mostly  4n  walk- 
ing, but  at  some  periods  on  horseback.  Though 
diligent  in  his  studies,  he  did  not  abstain  from 
social  intercourse.  His  disposition  would  have 
forbidden  this,  and  his  company  was  so  much 
13 


146  NOTES. 

coveted,  that  it  would  have  been  very  difficult  for 
him  to  have  done  so.  He  never  passed  his  sum- 
mers in  the  city.  He  valued  good  healtli,  and 
he  succeeded  in  maintaining  it  in  a  certain  degree. 
The  transient  observer  might  have  considered  him 
as  very  healthy,  so  bright  was  his  countenance, 
and  so  cheery  was  his  temper.  He  was  however 
hable  to  dyspeptic  troubles,  more  or  less,  and  the 
functions  of  the  colon  were  performed  very  slug- 
gishly, from  causes  I  have  referred  to.  But,  so 
far  as  I  can  recollect,  he  never  had  any  serious 
disease,  by  which  he  was  confined  to  the  house, 
until  the  occurrence  of  the  disease  in  his  head. 
This  was  on  the  fourth  of  February,  1858.  For 
a  year,  or  more,  he  had  been  annoyed  by  head- 
ache more  frequently  than  usual,  and  this  had 
sometimes  been  quite  severe.  He  had  likewise 
had  frequent  flushings  of  the  face,  sometimes 
amounting  to  an  unusual  redness,  through  a  great 
part  of  the  day.  He  mentioned  these  things  to 
me,  and  on  two  or  three  occasions  called  my 
attention  to  them  in  an  especial  manner.  But 
they  rarely  interrupted  his  habitual  labors,  and 
did  not  materially  interfere  with  the  common 
bodily  functions.  I  did  not  regard  the  complaints 
as  trivial,  yet  they  did  not  seem  to  demand  the  aid 


NOTES.  147 

of  medicine,  and  I  advised  only  the  precautions 
as  to  diet  and  regimen,  which  would  naturally 
suggest  themselves.  On  the  fourth  of  Feb.  1858, 
I  was  summoned  to  him  in  haste,  when  I  found 
him  on  his  couch,  and  heard  the  following  story. 

He  had  not  appeared  well  the  evening  of  the 
preceding  day.  He  then  complained  of  head- 
ache, and  of  numbness  in  his  right  leg.  He  was 
heavy  and  sleepy.  His  wife  read  to  him  some- 
thing sufficiently  agreeable,  but  he  did  not  take  an 
interest  in  it ;  he  was  so  sleepy  that  she  stopped 
reading.  He  attempted  to  write  a  note,  not  on 
any  complicated  affair,  but  gave  it  up,  because  he 
became  confused.  The  next  morning  he  said  that 
he  was  sensible  of  something  unusual  the  preced- 
ing evening,  that  his  mind  was  in  some  way  over- 
come, and  especially  that  he  could  not  remember 
names.  None  of  these  things  arrested  great  atten- 
tion at  the  time,  as  he  was  able  to  rouse  himself, 
and  then  seemed  well  enough.  On  referring  to 
these  tilings  in  the  morning  he  seemed  depressed 
in  his  spirits.  But  after  a  while  he  became  bright 
and  cheerful,  and  pursued  his  usual  course.  At 
the  accustomed  hour  he  went  to  walk,  but  on  his 
return  he  showed  some  uneasiness  at  not  finding 
Mrs.  Prescott  at  home.     The  maid-servant  noted 


148  NOTES. 

that  he  did  not  appear  well,  and  was  led  to  render 
him  unusual  attentions.  He  went  up  stairs,  and 
ordering  some  articles  to  be  brought  to  hhn  as  a 
lunch.  He  subsequently  said,  that  before  reaching 
his  library,  he  felt  some  failure  in  his  legs,  es- 
pecially in  mounting  the  last  few  stairs.  When 
the  maid  entered  his  room,  soon  afterwards,  she 
found  him  looking  uncomfortably,  and  he  ex- 
pressed to  her  a  feeling  of  uneasiness,  and  begged 
her  to  go  for  Mrs.  Prescott,  who  was  in  a  neigh- 
boring house.  On  her  arrival  Mrs.  Prescott  was 
satisfied  that  he  had  some  real  malady,  and  feared 
it  was  a  paralysis.  She  got  him  on  a  couch  and 
sent  for  me.  This  was  about  2,  p.  m.  On  my 
arrival,  he  was  on  the  couch,  but  not  quite  pros- 
trate ;  his  head  was  raised  up,  and  he  was  looking 
round  with  an  unnatural  expression  of  counte- 
nance, and  seeming  to  be  bewildered  ;  yet  he  evi- 
dently knew  those  about  him.  He  attempted  to 
speak,  but  was  unable  to  command  words,  and  his 
utterance  was  very  imperfect  and  indistinct.  He 
seemed,  however,  to  understand  in  some  measure 
what  was  said  to  him,  and  complied,  as  to  his 
movements,  with  our  requests.  He  was  able  to 
move  all  his  limbs,  but  the  command  of  his  right 
hand  and  arm  was  evidently  not  so  perfect,  as  that 


NOTES.  149 

of  tlie  other  limbs.  He  had  some  retching  and 
nausea.  He  had  complained  that  he  was  weary, 
and  had  had  some  twitching  of  the  limbs.  He 
w^as  not  flushed ;  his  respiration  was  not  labored, 
though  it  had  the  irregularity  attending  emotion 
of  the  mind,  and  his  pulse  was  nearly  normal.  I 
had  him  placed  on  a  bed,  after  removing  his  su- 
perfluous dress,  and  after  a  little  deliberation  I 
decided  not  to  bleed  him,  but  to  administer  Ipecac 
as  an  emetic.  He  took  three  doses  of  the  powder, 
a  scruple  each,  and  after  a  long  interval  he  vomited 
rather  copiously.  He  did  not  throw  off*  any  food, 
but  only  the  liquids  of  the  stomach,  with  some 
bile.  The  strong  excitement  of  the  stomach 
seemed  evidently  to  be  salutary.  Almost  imme- 
diately after  it  he  got  a  better  use  of  the  organs 
of  speech,  and  his  mind  became  more  clear.  He 
mended  during  the  evening,  and  his  night  was 
tranquil. 

The  next  morning  I  found  him  in  a  state  com- 
paratively comfortable,  up  and  dressed.  Generally 
his  senses  and  intelligence  were  satisfactory,  but 
his  eyesight  was  more  than  usually  imperfect. 
In  attempting  to  read,  he  said  the  words  became 
confused,  and  especially  he  noted  that  some  one  or 
more  of  the  words  would  drop  down  from  one  line 


150  NOTES. 

to  a  lower  one.  This  difficulty  continued  for 
many  weeks,  but  gradually  diminished.  By  de- 
grees, he  seemed  capable  of  bringing  up  the  word 
which  had  fallen  out  of  its  place,  and  sometimes 
instead  of  a  whole  word,  one  letter  only  would 
fall  down.  On  the  same  day,  or  soon  after,  he 
noticed  some  peculiar  spectra^  and  these  continued 
to  return  for  many  days.  They  would  appear 
while  he  was  wide  awake,  in  full  day-light,  and 
with  his  friends  about  him.  Principally  he  noted 
that  certain  gentlemen,  neatly  dressed  in  black, 
would  march  round  the  room  in  regular  order, 
and  gradually  slide  out  of  sight.  He  would  say, 
"  There  go  my  gentlemen,"  or  words  to  that 
effect. 

To  the  common  muscce  volitantes  he  had  been 
accustomed  from  the  period  of  his  rheumatic  fever, 
under  some  varieties  of  form.  These  continued 
and  increased  somewhat.  On  the  5th  of  Feb- 
ruary, the  morning  after  his  attack,  he  inquired 
into  and  discussed  the  history  and  nature  of  his 
disease,  telling  us  all  that  he  could  recollect  of  it. 
He  was  never  satisfied,  when  at  all  unwell,  with- 
out the  most  full  explanation  of  his  symptoms.  I 
did  not  attempt  to  hide  from  him  the  true  char- 
acter of  his  present   disease;    on   the  contrary,  I 


NOTES.  151 

wished  him  to  be  sensible  of  it,  that  he  might 
know  how  strong  were  the  inducements  to  comply 
with  my  prescriptions.  I  told  him  that  his  disease 
was  apoplexy,  though  very  slight  in  degree,  and 
that  a  repetition  of  it  was  to  be  feared.  I  ex- 
plained to  him  the  advantage  of  placing  his  reli- 
ance on  diet  and  regimen,  rather  than  on  drugs 
and  medical  treatment.  Especially,  I  stated  the 
benefit  from  an  entire  abstinence  from  animal 
food.  I  also  advised  an  abstinence  from  vinous 
and  spirituous  hquors.  He  entered  into  my  plan 
with  great  readiness  and  adhered  to  it  very  stead- 
ily. He  also,  at  my  suggestion,  gave  up  his 
books  and  his  pen,  and  avoided  all  intellectual 
efforts  and  all  moral  excitements. 

He  very  soon  got  abroad,  and  he  returned  grad- 
ually to  his  accustomed  walks,  and  cautiously 
resumed  a  pleasant  intercourse  with  his  friends. 
Such,  however,  were  his  habits  of  industry  that 
the  time  hung  heavily  on  his  hands,  so  that  in 
three  months  after  his  attack,  I  advised  him  to 
resume  his  studies,  provided  that  this  should  be 
done  in  a  very  moderate  and  gradual  manner. 
Subsequently,  he  had  the  little  variations  in  his 
feelings  common  to  all  men,  whose  vigor  is  in  any 
measure  impaired.     But  on  the  whole,  his  health 


152  NOTES. 

was  getting  more  perfect,  through  the  succeeding 
summer  and  autumn.  When  he  returned  from 
the  country  in  November,  his  appearance  was  very- 
satisfactory.  The  flushing  of  his  face  had  disap- 
peared, and  his  headaches  had  very  much  dimin- 
ished, from  the  period  of  his  sickness  in  February. 
His  muscular  strength  was  very  good,  though  not 
quite  so  great  as  in  the  preceding  years.  His 
walks  amounted  to  four  or  five  miles  a  day.  He 
had  gone  through  much  literary  labor,  and  in 
December  he  brought  out  the  third  volume  of 
Philip  the  Second.  We  were  greatly  encouraged. 
He  was  not  free  from  headache,  and  occasionally 
spoke  of  some  unfavorable  symptoms ;  but  he  was 
on  the  watch  for  such,  though  he  maintained  a 
cheerful  spirit.  He  never  recovered  fully  the 
hilarity,  for  which  he  had  been  so  much  distin- 
guished during  his  life,  and  perhaps  his  mind  was 
less  rapid  in  its  operations  than  formerly.  But, 
if  not  hurried,  his  intellect  was  equal  to  its  accus- 
tomed tasks,  and  I  believe  that  the  most  exact 
critic  would  not  discover  in  the  printed  sheets  any 
evidence  that  its  author  was  incapable  of  what  he 
had  undertaken.  He  distrusted  himself  at  times, 
btu  he  could  not  show  that  he  had  made  any  real 
false  step. 


NOTES.  153 

After  the  publication  of  his  last  volume,  Mr. 
Prescott  allowed  himself  a  little  vacation  before 
entering  on  a  new  task.  During  this  time  he 
learnt  with  how  much  pleasure  and  delight  the 
new  volume  had  been  received  and  criticized  by 
those,  who  were  most  competent  to  estimate  its 
merits.  But,  after  a  few  weeks,  he  began  to  look 
with  feelings  of  pleasure  to  the  renewal  of  his 
studies,  and  on  the  morning  of  the  28th  of  Jan- 
uary last,  he  stated  to  his  wife  that  it  was  time 
for  him  to  begin,  and  that  he  felt  prepared.  On 
that  very  day,  about  noon,  the  great  change  oc- 
curred. He  was  for  the  moment  alone,  in  a 
closet,  when  his  faithful  secretary  heard  an  un- 
usual sound  there.  He  went  to  him  immediately, 
and  found  him  in  a  state  of  complete  apoplexy. 
He  was  entirely  insensible,  he  performed  no  vol- 
untary motion,  and  his  respiration  soon,  if  not  at 
first,  became  stertorous.  His  whole  face  was 
changed ;  his  features  were  altered ;  all  influence 
of  the  mind  upon  them  had  ceased.  He  continued 
in  this  state  between  two  or  three  hours,  and  then 
expired,  surrounded  by  those  he  most  loved.  With 
what  feelings  the  result  was  witnessed  by  them, 
and  what  impression  it  made  on  the  community 
as  the  news  was  spread  abroad,  how   every  one 


154  NOTES. 

felt  the  great  void  that  was  k'ft,  it  belongs  to  you, 
my  dear  sir,  to  tell.  Allow  nie  a  few  remarks  on 
the  case  as  viewed  medically. 

It  would  perhaps  have  been  sufficient,  my  dear 
Mr.  TIcknor,  if  I  had  confined  myself  to  a  brief 
and  plain  statement  of  the  morbid  aflPections  which 
occurred  in  our  lamented  friend  ;  —  of  the  imper- 
fect vision,  apparently  an  obstacle  to  all  literary 
pursuits,  but  which  did  not  prevent  the  most  ex- 
tensive researches,  and  the  most  minute  scrutiny 
in  the  fields  of  learning ;  —  and  of  the  lesion  of 
the  brain,  ultimately  of  the  fatal  affection  of  that 
organ,  by  which  in  an  instant  a  mind  so  enlarged, 
so  powerful,  so  comprehensive,  so  splendid  in  its 
manifestations,  so  adorned  by  moral  beauty, — by 
which,  in  one  instant  this  mind,  —  not  one  last 
look  allowed  even  for  those  most  tenderly  beloved, 
—  was  at  once  separated  from  all  that  is  earthly. 
But  let  me  not  seem  to  lament  the  mode  of  his 
death,  by  which  it  would  almost  seem  as  if  a  kind 
Providence  had  granted  his  repeated  prayer;  by 
which  he  was  saved  the  pangs  of  a  separation  he 
dreaded  to  meet. 

I  have  allowed  myself  to  go  out  of  my  path. 
I  meant  only  to  apologize  for  the  length  and  mi- 
nuteness   of    detail,    in    which    I   have    indulged 


N0TE3.  155 

mvself,  and  of  the  discussion  even  of  the  propriety 
of  the  treatment  adopted  in  Mr.  Prescott's  case. 
I  know  it  is  more  than  most  readers  will  care  for. 
I  hope,  therefore,  that  you  Avill  put  this  letter  into 
an  appendix,  where  it  may  be  found  by  those,  who 
desire  to  see  it.  I  could  not  write  it  without 
realizing  that  medical  men,  as  well  as  others, 
would  be  interested  in  the  life  of  Mr.  Prescott, 
and  I  wished  to  give  them  satisfaction  as  regards 
the  details  of  his  case,  viewed  professionally.  It 
is,  in  reality,  veiy  interesting  as  a  medical  case. 
And  now,  for  them,  I  wish  to  add  a  few  more 
w^ords  ;  such,  I  mean,  as  relate  to  the  treatment 
after  the  first  apoplectic  attack. 

I  have  elsewhere*  given  to  professional  readers 
my  views  on  the  importance  of  diet  in  warding 
off  a  second  attack  of  paralysis  ;  such -attacks  as 
are  very  commonly  due  to  sudden  hemorrhages 
within  the  cranium.  These  hemoiThages  cause 
perfect  apoplexy  when  they  arrive  at  a  certain 
amount,  but  when  more  slight,  they  cause  paraly- 
sis only.  My  experience  has  led  me  gradually  to 
the  belief  that  the  risk  of  a  recurrence  of  the 
hemorrhage  may  be  much  diminished  by  entire 

*  Letters  to  a  Young  Physician. 


156  NOTES. 

abstinence  from  animal  food.  I  do  not,  in  every 
case,  regard  an  entire  abstinence  from  diffusible 
stimulants  so  essential,  as  the  abstinence  from  the 
food  in  which  nitrogen  most  abounds.  In  various 
instances  I  have  adopted  this  practice  with  favor- 
able results,  and  among  them  were  men  very  near 
and  dear  to  me.  I  did  indulge  a  strong  hope  in 
the  case  of  our  friend,  that  I  should  be  gratified 
with  a  like  result,  though  I  never  supposed  that 
the  same  could  happen  in  every  instance.  I  was 
able  to  infuse  into  his  mind  much  of  the  same 
hope.  I  have  suffered  a  most  grievous  disappoint- 
ment. But  I  trust  one  failure,  though  in  a  veiy 
memorable  case,  will  not  deter  my  brethren  from 
a  trial  of  the  same  mode  of  treatment.  More  ex- 
perience is  required  to  decide  its  merits.  But,  let 
it  be  noted,  it  is  not  attended  by  the  hazards  of  a 
powerful  drug. 

I  am,  my  dear  Sir, 

Very  sincerely,  your  friend, 

James  Jackson. 

Georqe  Ticknor,  Esq. 
Hamilton  Place,  June  1st,  1859. 


MEMOIR 


ON    THE 


LAST   SICKNESS   OF 

GENEEAL   WASHINGTON 


AND    ITS 


TREATMENT  BY  THE  ATTENDANT  PHYSICIANS. 


MEMOIR. 

The  death  of  General  Washington  took  place 
unexpectedly  after  an  illness  of  less  than  forty- 
eight  hours.  He  was  in  his  sixty-eighth  year, 
but  had  not  begun  to  show  much  of  the  infirmi- 
ties of  age.  Under  the  exposures  of  the  active 
period  of  his  life,  and  again  shortly  after  he  had 
engaged  in  the  heavy  cares  and  responsibilities  of 
office  in  1789,  he  had  undergone  severe  acute 
diseases  ;  but  it  does  not  appear  that  he  had  been 
suffering  under  any  wearing  or  wasting  chronic 
malady.  His  faithful  biographer,  Mr.  Sparks, 
says  of  him,  that  *'  Since  his  retirement  from  the 
presidency,  his  health  had  been  remarkably  good ; 
and  although  age  had  not  come  without  its  infir- 
mities, yet  he  w^as  able  to  endure  fatigue,  and 
make  exertions  of  body  and  mind  with  scarcely 
less  ease  and  activity  than  he  had  done  in  the 
prime  of  his  strength."  *  Such  being  the  case, 
the  circumstances  of  his  short  disease,  its  character 

•  Sparks's  Life  of  Washington y  p.  528. 

[159] 


160  MEMOIR    ON    THE    LAST    SICKNESS 

viewed  scientifically,  and  the  treatment  adopted 
by  his  physicians,  have  all  been  ascertained  and 
discussed ;  and  the  remedies  employed  have  been 
spoken  of  by  some  persons  in  terms  of  strong  ap- 
probation. 

We  derive  the  only  original  account  of  his 
disease  from  a  statement  made  out  by  Colonel 
Lear  within  twenty-four  hours  after  his  decease, 
with  an  attestation  to  the  correctness  of  this 
account  made  at  the  time,  "  so  far  as  he  could 
recollect,"  by  his  excellent  friend  and  physician, 
Dr.  Craik.  This  account  has  the  appearance  of 
accuracy  and  fidelity.  It  is  consistent  with  itself, 
and  accords  with  what  is  now  known  to  belong 
to  the  disease,  which  cut  short  the  days  of  this 
great   man. 

On  the  12th  of  December,  1799,  he  was  abroad 
on  his  farms,  on  horseback,  from  10  o'clock,  a.  m. 
to  3,  p.  M.  ;  and  "  soon  after  he  went  out  the 
weather  became  very  bad ;  rain,  hail,  and  snow 
falling  alternately,  with  a  cold  wind."  To  the 
watchfiil  eyes  of  his  family  there  were  no  appear- 
ances of  disease,  though  they  looked  for  them, 
until  the  next  day.  He  then  complained  of  a 
sore  throat,  and  it  became  evident  that  he  had 
taken   cold  ;   "  he  had    a   hoarseness,    which   in- 


OF    GExNERAL    WASHINGTON.  161 

creased  in  the  evening ;  but  he  made  hght  of  it." 
So  far  from  feehng  anything  hke  serious  ilhiess 
on  this  13th  of  December,  he  seems  to  have  been 
kept  from  "  riding  out,  as  usual,"  only  by  a  snow- 
storm. In  the  afternoon  he  went  out  of  the  house 
to  look  after  some  work,  which  was  not  of  an 
urgent  character.  He  passed  his  evening  as  usual, 
and  did  not  seem  to  be  aware  that  his  cold  was 
uncommonly  severe.  When  Colonel  Lear  pro- 
posed at  bedtime  that  he  should  take  "  something 
to  remove  his  cold,"  he  answered,  "  No,  you  know 
I  never  take  anything  for  a  cold  ;  let  it  go  as 
it  came." 

It  was  in  this  night  that  his  sickness  arrested 
his  attention.  He  was  taken  with  an  ague,  and, 
between  two  and  three  o'clock  on  Saturday  morn- 
ing, (the  14th,)  he  awoke  Mrs.  Washington  and 
told  her  that  he  was  very  unwell.  He  then  had 
great  difficulty  in  breathing^  speaking  and  swallow- 
ing. These  are  the  symptoms  which  are  charac- 
teristics, the  essential  characteristics,  of  his  disease. 
They  continued  till  his  death,  which  took  place 
between  10  and  11  o'clock  in  the  following  night. 
There  seem  to  have  been  some  hours  during  which 
he  did  not  swallow  anything,  in  consequence  of 
the  distress  attending  any  effort  to  do  it.  It  was 
14 


162  MEMOIR    ON    THE    LAST    SICKNESS 

also  SO  difficult  to  speak,  that  he  did  that  only 
when  he  thought  it  important,  and  as  briefly  as 
was  consistent  with  his  habitual  care  to  be  distinct 
and  definite  in  his  expressions.  It  was  the  breath- 
ino-,  howcA'Cr,  Avhich  caused  him  most  distress.  In 
reo-ard  to  that  the  patient  cannot  choose,  as  he 
can  in  respect  to  speaking  and  swallowing.  The 
efforts,  which  he  was  compelled  to  make  in  breath- 
ing, were  extremely  distressing,  and  occasioned 
great  restlessness  ;  —  the  more  because  his  strong- 
est eftbrts  were  insufficient  to  supply  his  lungs 
with  as  much  air  as  his  system  had  need  of.  It 
was  from  the  inability  to  do  this  that  death  en- 
sued. He  was  in  fact  strangulated  by  the  closure 
of  the  windpipe,  as  much  as  if  a  tight  cord  had 
been  twisted  around  his  neck.  His  intellect  re- 
mained unclouded,  and  it  is  needless  to  say  that 
he  showed  to  the  last  those  strong  and  great 
characteristics  of  mind  and  heart,  by  which  his 
whole  life  had  been  marked. 

What  was  this  disease  which  cut  down  a  strong 
man  in  so  short  a  time  ?  It  was  such  as  has  cut 
down  very  many,  no  doubt,  in  times  past ;  but 
it  is  a  rare  disease.  It  had  not,  at  the  time  of 
Washington's  death,  been  clearly  described,  so  as 
to  be  distinguished   from  other   diseases  about  the 


OF    GENERAL    WASHINGTON.  163 

throat.  It  is  now  well  known  under  the  name  of 
acute  laryngitis  ;  —  inflammation  of  the  larynx,  — 
the  upper  part  of  the  windpipe.  It  was  about 
1810  that  this  morbid  affection  was  first  brought 
into  notice  and  distinctly  described  by  Dr.  Mat- 
thew Baillie,  of  London,  confessedly,  while  he 
lived,  at  the  head  of  his  profession  in  that  great 
city.  He  published  t^vo  cases  seen  by  himself, 
both  of  them  within  a  short  period,  both  in  medi- 
cal men,  and  one  of  these  a  very  dear  friend  of 
his.  To  these  cases  he  added  a  third  reported  to 
him  by  a  practitioner  in  London,  which  was  evi- 
dently like  the  other  two.  He  ascertained  the 
morbid  changes,  by  which  these  persons  had  been 
suddenly  deprived  of  life,  by  examinations  after 
death.  It  was  ascertained  by  these  examinations, 
as  it  has  been  by  many  made  since  in  similar 
cases,  that  the  disease  consists  in  an  inflammation 
in  the  mucous  membrane  of  the  whole  larynx,  in- 
cluding the  epiglottis  ;  but  that  this  inflammation 
is  not  limited  to  the  mucous  membrane.  It  ex- 
tends to  the  cellular  membrane  subjacent  to  the 
other,  indeed  to  all  the  soft  parts,  including  the 
muscles  ;  and  perhaps,  in  some  degree,  to  the 
cartilages.  From  these  morbid  changes  the  epi- 
glottis is  disabled  from  the  free  and  ready  motion 


16 i  MEMOIR    ON    THE    LAST    SICKNESS 

essential  to  its  office,  which  is  that  of  guarding 
the  windpipe  from  the  admission  of  substances 
passing  through  the  pharynx.  Hence  one  of  the 
difficulties  in  swallowing;  probably  the  greatest. 
In  such  a  state  the  attempt  to  swallow  any  sub- 
stance, liquid  or  solid,  would  be  attended  by  an 
instinctive  effi)rt  of  the  epiglottis  to  shut  up  the 
larynx,  as  it  always  does  in  health  during  the  act 
of  swallowino-.  But  this  instinctive  effi^rt  must 
cost  great  pain  ;  and  it  is  an  effi^rt  which  could 
not  succeed  in  the  most  severe  state  of  tlie  disease. 
Thus  the  principal  difficulty  in  swallowing  is  ex- 
plained. Another  difficulty  in  swallowing  arises 
from  the  state  of  the  phaiynx.  The  inflammation 
of  the  larynx  passing  over  its  posterior  part,  in  some 
if  not  all  cases,  spreads  to  the  pharynx,  and  dis- 
ables that  part  from  performing  its  office  in  cariy- 
ing  down  the  liquids  or  solids  brought  to  it. 

Just  below  the  entrance  to  the  larynx  we  find 
the  delicate  structures  belonging  to  the  organ  of 
the  voice,  and  here  is  the  narrowest  part  of  the 
air  tube.  In  these  parts,  a  common  acute  inflam- 
mation of  their  mucous  membrane  will  cause  sore- 
ness and  hoarseness  ;  but  when  the  disease  extends 
to  the  subjacent  cellular  membrane,  so  that  all 
these   parts   are   thickened   by  the   distension   of 


OF    GENERAL    WASHINGTON.  165 

the  small  bloodvessels,  and  the  more  if  there 
take  place  an  effusion  of  an}^  fluid  into  this  cellu- 
lar membrane,  it  is  seen  at  once  how  these  soft 
parts  must  be  swollen.  Now  this  swelhng  occa- 
sions a  difficulty,  if  not  an  impossibility,  of  motion 
in  the  delicate  parts  belonging  to  the  organ  of 
the  voice,  and  accounts  for  the  difficulty  and  at 
length  the  impossibility  of  speaking.  At  the  same 
time  we  see  how  the  passage  of  the  air  is  im- 
peded, and  at  last  entirely  obstructed,  producing 
the  difficulty  of  breathing  and  at  length  the  stran- 
gulation. 

Thus  this  disease,  so  suddenly  destructive  of 
life,  is  among  the  most  simple  in  its  nature.  One 
readily  understands  that  his  fingers  may  be  in- 
flamed, that  is,  become  red,  swollen,  indurated 
in  all  the  soft  parts,  and  painful,  to  such  a  degree 
as  to  make  motion  in  them  veiy  difficult  and  at 
length  impossible.  But  all  this  may  take  place 
without  interfering  with  functions  important  to 
life.  But  let  the  organs  by  which  the  voice 
is  formed  and  through  which  the  air  must  be 
passed  for  the  supply  of  the  lungs,  —  the  organs 
through  which  the  breath  of  life  must  have  an 
open  road,  —  let  these  organs  be  swollen  and 
rigid   so   as   to   block   up   this   passage,   and   we 


166  MEMOIR    ON    THE    LAST    SICKNESS 

readily  comprehend  that  life  may  be  arrested 
in  young  or  old,  in  the  strong  as  well  as  in  the 
feeble,  in  a  very  short  space  of  time.  It  follows 
that  the  only  question  in  a  disease  of  this  kind, 
as  it  occurs  in  adults,  is  whether  we  can  prevent 
or  remove  the  fatal  obstruction,  wdiich  has  been 
described  as  characteristic  of  this  disease. 

There  are,  however,  some  further  remarks  to 
be  made  on  the  disease,  before  discussing  the 
treatment  of  it.  Any  one  conversant  with  the 
subject  will  see  at  once  how  much  acute  laryngi- 
tis resembles  the  common  affection,  which  we  all 
know  as  a  sore  throat  from  a  cold.  Thouoh 
the  words  a  cold  are  employed  with  reference 
to  any  disease,  which  is  thought  to  arise  from 
an  exposure  to  a  change  of  temperature,  or  to 
cold  and  damp  weather,  they  are  most  commonly 
used  in  reference  to  an  attack  in  the  nose,  or  in 
the  windpipe.  These  are  called  colds  in  the  head, 
or  colds  in  the  throat.  The  cold  in  the  throat 
is  marked  by  a  sense  of  slight  soreness  in  that 
part,  especially  felt  in  deglutition  and  in  cough- 
ing, and  by  hoarseness  in  the  voice.  Some  cough 
soon  follows  and  presently  an  expectoration  of 
matter,  at  first  watery  and  afterw'ards  thick  and 
glutinous,   and    more   or   less   opaque.     In   these 


OF    GENERAL    WASHINGTON.  167 

cases  there  is  an  inflammation  of  the  mucous 
membrane  of  the  larynx.  The  disease  may  beoin 
in  the  nasal  passages,  when  it  is  commonly  called 
a  cold  in  the  head,  or  a  nasal  catarrh ;  and  this 
does  most  frequently  take  place  first ;  but  which- 
ever part  is  affected  first,  the  inflammation  may 
extend  fi-om  this  to  the  other.  Further,  when 
the  larynx  is  affected,  the  inflammation  may  also 
pass  downward  to  the  bronchi,  which  are  the 
ramifications  of  the  windpipe  in  the  lungs.  Then 
the  disease  gets  the  name  of  pulmonary  catarrh, 
or  bronchitis. 

To  one  who  understands  the  above  statement, 
it  will  be  plain  that  the  cold  in  the  throat,  when 
there  take  place  soreness  in  the  throat,  hoarse- 
ness, a  slight  difficulty  in  deglutition,  and  more 
or  less  cough,  —  in  other  words,  a  hoarse  sore 
throaty  is  the  same  thing  as  the  acute  laryngitis. 
It  is  assuredly  the  same  thing,  except  in  degree. 
In  the  disease  first  described,  the  laryngitis^  the 
inflammation  is  more  severe,  and  it  is  not  con- 
fined to  the  mucous  membrane,  but  extends  to  the 
other  tissues.  The  mucous  membrane  may  be 
called  an  internal  skin;  and  like  the  skin  it  is 
connected  with  other  parts  by  a  cellular  mem- 
brane.    Now  if  the  skin  be  inflamed   in  its  ex- 


163  MEMOIR    ON    THE    LAST    SICKNESS 

ternal  surface  only,  in  one  man,  and  in  another 
an  inflammation  of  the  skin  should  pass  through 
it  into  the  subjacent  cellular  membrane,  the  swell- 
ins:  would  be  much  more  in  this  last  case  than 
in  the  first.  The  greater  swelling  in  the  second 
case  would  be  attended  with  more  general  affec- 
tion of  the  system  than  would  occur  in  the  first 
one.  So  far  the  difference  between  the  common 
affection  of  the  larynx,  in  ordinary  colds,  and 
that  in  the  severe  disease  under  consideration, 
is  illustrated  by  the  supposed  inflammation  in 
the  skin  in  the  two  men.  But  there  is  one  great 
difference.  The  swelling  of  the  skin  is  not  pro- 
ductive of  any  serious  inconvenience ;  not  so  in 
the  larynx.  That  is  the  tube  through  which  the 
air  passes  to  the  lungs  in  respiration,  and  in  one 
part  the  passage  is  very  narrow.  In  this  part 
the  swelling  must  occupy  the  calibre  of  the  tube ; 
in  fatal  cases  it  fills  up  the  air  passage ;  and  the 
effect  of  this  is  the  same  as  if  a  cord  were  tied 
very  tightly  around  the  neck.  As  the  passage 
is  filling  up,  the  air  passes  with  more  and  more 
difficulty,  and  at  last  it  cannot  pass  at  all.  Even 
this,  however,  does  not  state  quite  the  whole. 
In  the  last  hours  of  life,  the  lungs  do  not  get 
air  enough  to  produce   the   requisite   change   in 


OF    GENERAL   WASHINGTON.  169 

the  blood  ;  and  likewise  the  carbonic  acid  gas, 
which  is  an  excretion  from  the  blood,  and  is 
usually  discharged  at  once  from  the  lungs,  is 
retained  in  some  measure  and  acts  as  a  poison. 
From  this  imperfect  renewal  of  the  blood,  if  we 
may  use  the  expression,  arises  the  livid  counte- 
nance in  the  last  hours  ;  and,  under  this  state  of 
the  blood,  every  part  of  the  body  is  constantly 
losing  its  vigor.  Thus,  before  the  larynx  is  abso- 
lutely blocked  up,  the  muscles  of  respiration  be- 
come incapable  of  the  effort  requisite  to  expand 
the  thorax,  and  death  ensues,  although  there  may 
be  a  very  small  passage  still  left  open  at  the  last 
moment  of  life. 

We  are  prepared  now  to  consider  the  treatment 
proper  in  acute  laryngitis,  in  connection  with  that 
adopted  in  the  case  under  consideration.  It  has 
been  thought  by  many  persons,  medical  and  non- 
medical, that  General  Washington  was  not  treated 
judiciously  ;  and  some,  perhaps,  beheve  that  by  a 
different  treatment  his  life  might  have  been  pre- 
served. Sixty  years  have  passed  since  his  decease, 
and  the  disease,  which  was  fatal  to  him,  is  under- 
stood now  much  more  perfectly  than  it  was  m 
1799.  To  what  result  have  we  arrived?  Has 
any  treatment  proved  to  be  more  successful  than 
16 


ITO  MEMOIR    ON    THE    LAST   SICKNESS 

that  adopted  in  his  case  ?  He  was  bled,  he  was 
blistered,  and  calomel  and  antimony  were  admin- 
istered internally.  Whether  these  remedies  were 
employed  early  enough,  and  whether  to  too  great 
an  extent,  or  not  sufficiently,  are  questions  to 
which  we  will  return  presently. 

What  was  the  treatment  adopted  by  Dr.  Baillie 
in  the  cases  of  his  medical  friends  ?  He  directed 
bleeding,  both  general  and  local,  and  his  patients 
not  only  agreed  with  him,  but,  being  medical 
men,  directed  it  for  themselves  in  his  absence. 
This  happened  at  a  period  comparatively  near  to 
that  of  Washington's  case. 

What  do  the  best  teachers  say  at  the  present 
day  ?  To  answer  this  question  fully  and  accu- 
rately would  require  great  research.  One  need 
not,  however,  hesitate  to  say,  generally,  that  they 
recommend  bleeding  and  blistering.  In  addition, 
the  English  teachers  advise  the  use  of  mercurials 
carried  to  the  point  of  salivation,  and  our  own 
did  the  same  until  very  lately.  Some  of  them, 
perhaps,  do  it  now.  Some,  if  not  many,  would 
add  antimony  and  opium  to  the  calomel,  or  other 
preparations  of  mercury. 

We  believe  that  the  lectures  by  Dr.  Watson  of 
Londoft   are  received    aa   good    authority,    by  as 


OF    GENERAL    WASHINGTON.  171 

many  persons  who  speak  the  English  language, 
as  the  work  of  any  writer  of  our  time  on  the 
theory  and  practice  of  medicine.  In  the  last 
edition  of  his  lectures  he  advises  bleeding  freely 
at  an  early  period  of  acute  laryngitis,  with  the 
qualifications  which  every  discreet  and  experi- 
enced practitioner  would  assent  to.  So  far,  then, 
it  would  seem  that  the  treatment  adopted  by  Dr. 
Craik  and  his  medical  coadjutors  is  the  same 
which  has  been,  and  is  now,  directed  by  physicians 
of  the  first  standing:. 

Let  us  look  into  this  matter  somewhat,  and  see 
whether  blood-letting  in  acute  laryngitis  appears 
to  be  a  rational  practice.  To  what  cause  is  the 
danger  to  life  to  be  attributed  in  this  disease? 
The  answer  has  already  been  given.  The  danger 
arises  from  the  filhng  up  of  a  part  of  the  wind- 
pipe. In  what  way,  or  by  what  material  is  the 
windpipe  filled  up  ?  By  an  extra  quantity  of 
blood  in  the  small  vessels  of  the  part,  similar  to 
what  most  persons  may  have  seen  in  a  violent 
inflammation  of  the  external  surface  of  the  eye. 
By  this  blood  in  the  first  instance,  and  in  part,  is 
the  tube  filled  up ;  but  fiirther,  by  the  effusion 
under  the  mucous  membrane  of  the  larynx  of  a 
watery  liquid,  called  serum,  or  serous  fluid.  When 


172  MEMOIR    ON    THE    LAST    SICKNESS 

a  man  is  bled  largely,  he  usually  becomes  pale. 
This  happens  because  the  small  vessels  of  the  ex- 
ternal surface  contract  under  the  loss  of  blood, 
and  the  skin  is  seen  to  be  white,  or  sallow,  accord- 
ing to  the  complexion  of  the  individual.  If,  in 
the  disease  under  consideration,  the  small  blood- 
vessels in  the  morbid  part  will  contract  as  those 
of  the  skin  do,  after  the  abstraction  of  blood,  we 
may  hope  for  relief,  as  long  as  that  contraction  is 
maintained.  Not  only  so  ;  it  will  be  found  that 
if  this  contraction  takes  place  in  the  diseased 
part,  the  effusion  of  serous  fluid  is  more  readily 
absorbed  than  it  would  otherwise  be. 

It  must  be  confessed  that  the  effect,  here  de- 
scribed, on  the  small  blood-vessels  in  the  morbid 
part,  is  not  certain  to  take  place  in  consequence 
of  the  loss  of  blood.  The  success  of  the  measure 
depends  mainly  on  the  period  of  disease,  at  which 
the  bleeding  takes  place.  The  chance  of  success 
is  great  in  the  very  beginning  of  the  inflammatory 
process ;  but  it  is  less,  the  later  the  period  at 
which  the  remedy  is  employed.  There  is  not, 
however,  any  other  measure  by  which  effectual 
relief  is  so  likely  to  be  produced  as  by  blood- 
letting. If  anything  else  can  be  equally  effectual, 
in  so  short  a  space  of  time,  it  must  be  some  local 


OF    GENERAL    WASHINGTON.  173 

applications  to  the  part  affected.  There  are  cases 
of  disease  in  the  larynx,  where  nitrate  of  silver 
and  other  articles  may  perhaps  be  applied  to  the 
parts  affected,  with  great  benefit.  But  in  the 
irritable  state  of  the  part  in  question,  in  this  acute 
disease,  such  applications  must  be  attended  with 
very  great  difficulty,  and  apparently  with  great 
hazard.  The  success  of  this  treatment  in  cases 
of  ulceration  in  the  mucous  membrane  of  the 
larynx,  in  a  chronic  disease,  does  not  prove  what 
would  happen  in  the  acute  disease  under  consid- 
eration. 

But  there  is  a  difficulty  which  ordinarily  attends 
the  bleeding  in  this  disease,  to  which  may  be  at- 
tributed the  failure  in  the  largest  proportion  of 
cases,  in  which  it  has  been  tried.  It  is  that  the 
disease  usually  commences  under  the  familiar  form 
of  a  common  cold  in  the  throat,  so  that  at  first  no 
alarm  is  felt.  Nor  ought  there  to  be  an  alarm  in 
such  a  case.  It  has  been  shown  above  that  such 
an  inflammation  as  occurs  in  a  common  hoarse 
cold^  may  suddenly  increase  in  importance  by  ex- 
tending from  the  mucous  membrane  or  tissue,  to 
the  surrounding  tissues,  especially  to  the  subjacent 
cellular  membrane.  Thence  comes  the  tumefac- 
tion, which,  acting   mechanically,   blocks  up   the 


174  MEMOIR    ON    THE    LAST    SICKNESS 

passage  of  tlie  air  into  tlie  lungs.  It  is  in  this 
first  stage,  before  the  fatal  extension  of  the  inflam- 
mation has  occurred,  that  the  disease  might  be 
the  most  easily  arrested.  But  who  would  advise 
the  active  treatment  requisite  for  this  purpose  in 
every  case  of  a  hoarse  cold^  which  is  the  first 
stage  ?  In  every  such  case  the  severe  disease 
may  ensue.  But  what  is  the  chance  that  it  will 
ensue  ?  A  very  large  proportion  of  persons,  prob- 
ably three  quarters  of  the  community  among  us, 
have  such  a  cold  once  a  year,  and  not  a  few  have 
such  an  attack  twice  or  three  times  in  a  year ;  but 
the  change  into  the  severe  disease,  called  acute 
laryngitis,  is  among  the  most  rare  occurrences. 
It  does  not  take  place  in  one  case  out  of  a  mil- 
lion. But  if  it  happened  in  one  case  in  a  hundred, 
it  would  not  be  justifiable  to  resort  to  a  severe 
treatment  in  each  one  of  a  hundred  cases,  in  order 
to  save  one  of  them  from  the  fatal  change.  There 
is  no  doubt  that  every  discreet  man  would  choose 
to  incur  the  slight  hazard  of  the  severe  disease, 
rather  than  to  resort  to  a  copious  bleeding  every 
rime  he  had  a  hoarse  sore  throat.  Washington 
was  evidently  familiar  with  a  cold  in  his  throat  in 
his  sixty-eighth  year,  as  other  men  are.  He  prob- 
ably   had  never  suspected    the   possible    issue  of 


OF    GENERAL    WASHINGTON.  175 

such  a  cold.  But  if  he  had  been  told  that  the 
chance  of  such  an  issue  was  one  in  a  million, 
or  even  one  in  a  hundred,  would  he  have  con- 
sented to  a  copious  bleeding?     We  think  not. 

Here  we  see  the  real   difficulty.     At  the  time 
when  the  danger  is  manifested,  the  disease  is  not 
strictly   new;    it   has    not    just   commenced.     Jn 
looking  over  the  histories  of  cases  of  acute  laryn- 
gitis, we  find  that  the  disease,  under  the  form  of  a 
hoarse  cold,  has  existed  from  a  few  hours  to  a  few 
days,  before  it  arrives  at  the  state  when  danger  to 
hfe  is  suspected.     It  cannot  be  said  that  the  bleed- 
ing, at  that  stage  of  the  disease,  can  be  relied  on, 
as  it  might  have  been  in  the  very  commencement. 
Yet  this  remedy,  even  then,  affords   a  chance  of 
relief,  and  the  more  when  the  disease  has  not  re- 
mained long  in  the  first  stage.     In  Washington's 
case  the  first  stage  was  of  short  duration.     Bleed- 
ing was  resorted  to  early,  by  his  own  direction. 
But  that  bleeding  was  nominal.    His  wife  objected 
to  it,  because  the  patient  was  old,  and  the  bleed- 
ing had  not  been  directed  by  a  physician.     AYe 
must   give    her   the    credit  of  exercising   a   wise 
caution.     Of  course  she  did  not  miderstand  the 
nature  of  the  disease;  she  did  not   suspect  how 
rapidly  it   was  pressing  forward   to   a   fatal   ter- 


176  MEMOIR    ON    THE    LAST    SICKNESS 

mination.  Even  the  delay  of  the  three  or  four 
hours  which  had  already  passed  away  since  he 
waked  her  in  the  night,  was  a  most  serious  loss. 
When  Dr.  Craik  reached  him,  some  hours  after- 
wards, he  prescribed  a  new  venesection.  He  was 
right ;  it  is  in  such  circumstances  that  the  anceps 
remedium  is  justifiable.  What  would  medical 
critics,  what  would  posterity  have  said,  if  tliis 
good  doctor,  when  such  a  patient  was  in  his 
hands,  in  imminent  danger  from  an  affection 
which  was  manifestly  due  to  an  inflammation,  had 
folded  his  arms,  and  said,  "  There  is  no  possibility 
of  giving  relief ;  but  you  may  let  him  inhale  the 
vapor  from  some  herb  tea?" 

Although  bloodletting  is  the  gi'eat  remedy, 
there  are  other  modes  of  treatment  which  may 
be  employed  in  aid  of  it,  or  without  it.  Calo- 
mel and  antimony,  usually  with  the  addition  of 
opium,  are  thought  by  many  physicians  to  be 
proper  articles  for  the  relief  of  this  laryngitis. 
Colonel  Lear  says  that  calomel  and  antimony 
were  given  to  General  Washington,  but  he  does 
not  say  in  what  doses,  nor  whether  more  than 
once.  There  is  not  any  reason  to  believe  that 
they  were  given  in  large  doses ;  though  I  think 
Dr.    Craik    and    his   coadjutors    have    been    re- 


OF    GENERAL    WASHINGTON.  177 

preached  on  this  score.  In  1799  the  use  of 
mercurials  in  inflammatory  diseases  was  very  rare, 
I  beUeve,  in  Great  Britain,  though  it  was  very 
common  in  this  country.  At  the  present  day 
the  reverse  is  true.  At  least  in  New  England 
the  practice  is  now  relied  on  much  less  than  in 
old  England.  Fashions  change,  it  must  be  ac- 
knowledged, in  medicine  as  in  other  things. 
Probably  the  result,  at  the  end  of  another  fifty 
years,  will  be  that  mercurials  will  not  be  ad- 
ministered in  either  country  as  freely,  as  they 
have  been  heretofore;  but  that  they  will  not 
be  abandoned  altogether. 

It  would  not  be  well  to  go  further  into  the 
subject  on  this  occasion.  We  have  considered 
the  bloodletting  more  fully  perhaps  than  was 
quite  necessary,  but  it  has  been  to  defend  the 
reputation  of  Dr.  Craik  and  his  medical  friends, 
who  we  think  did  as  well,  at  least,  as  any  of  their 
critics  would  have  done.  We  must  acknowl- 
edge an  unwillingness  not  to  think  well  of  Dr. 
Craik,  who  was  the  personal  friend  of  Washing- 
ton through  his  life. 

Passing  by  some  other  modes  of  treatment  for 
acute  laryngitis,  we  should  not  omit  to  notice 
one,  on  which   much   reliance   is   placed   at   the 


178  MEMOIR    ON    THE    LAST    SICKNESS 

present  day,  when  it  becomes  obvious  that  all 
other  remedies  are  ineffectual.  This  consists  in 
an  opening  into  the  trachea,  below  the  diseased 
part.  In  this  way  life  may  be  prolonged  while 
a  chance  is  afforded  for  the  subsidence  of  the 
disease  by  a  natural  process,  after  which  the 
wound  may  be  allowed  to  heal  up.  This  prac- 
tice has  been  resorted  to  with  success  in  various 
instances  of  obstructions  in  the  windpipe,  and 
especially  of  late  in  croup.  In  this  disease  of 
children  and  in  the  acute  laryngitis  of  adults,  it 
is  important  that  the  surgical  operation  should 
be  performed,  before  the  vital  powers  have  been 
too  much  exhausted,  by  the  painful  and  wearing 
struggles  for  life. 

But  it  is  time  to  bring  this  memoir  to  a  close. 
On  some  points  the  writer  has  gone  into  a  minute 
statement  of  particulars,  and  into  a  discussion  of 
principles,  as  to  the  pathology  and  as  to  the 
therapeutics.  But  this  has  been  done  only  so 
far  as  seemed  to  him  necessary  to  make  the  sub- 
ject understood  by  non-professional  men ;  not 
with  any  pretence  to  bring  into  view  all  that 
relates  to  the  disease  or  its  treatment.  If  he 
seem  to  have  lingered  on  the  subject  too  long, 
it  will  be  remembered   that   the   interest  which 


OF    GENERAL    WASHINGTON.  179 

is  inspired  by  every  circumstance  in  the  life  of 
Washington,  attaches,  with  melancholy  intensity, 
to  the  disease  by  which  that  life  was  suddenly 
brought  to  a  close. 

Boston,  March,  1860. 


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Goethe. 

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by   TiCKNOR    AND    FlELDS. 

Rev.  F.  W.  Robertson. 


Sermons. 

First  Series, 

Sl.OO. 

(( 

Second    " 

$1.00. 

it 

Third      " 

$1.00. 

t( 

Fourth    " 

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8         A  LiSl  of  Books  Publiflied 
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of  "  School  Days  at  Rugby.''     1  vol.  16mo.     $1.00. 
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by   TiCKNOR    AND    FlELDS.  9 

R.  H.  Dana,  Jr. 

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"  Two  Years  before  the  Mast."    75  cents. 

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-    Prose. 

[poetry.] 

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Kemble's  (Mrs.)  Poems.     1  vol.    $1.00. 


10       A  Li§l  of  Books  Publifhed 


Lockhart's  (J.  G.)  Spanish  Ballads.    With  Portrait. 

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cents. 
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Tuckerman's  Poems.     1  vol.     75  cents. 
Warreniana.     1  vol.     63  cents. 

[prose.] 

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Edited  by  A.  P.  Stanley.    2  vols.    12mo.     Cloth.    $2.00. 


by   TiCKNOR   AND    FlELDS.  11 


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American  Institute  of  Instruction.  Lectures  deliv- 
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12       A  LiSl  of  Books  Publifhed 


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by   TiCKNOR    AND    FlELDS.  I3 


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14       A  LiSl  of  Books  Publifhed 


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«  "        The  Preservation  of  Health. 

1  vol.    38  cents. 


by   TiCKNOR    AND    FlELDS.  I5 


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tophei-  Wordsworth,    2  vols.     16mo.     Cloth.    $2.50. 
Wensley:  a  Story  without  a  Moral.    1  vol.  16mo. 

Paper.     50  cents. 
The  Same.     Cloth.     75  cents. 
Wheaton's  (Robert)  Memoirs.     1  vol.    16mo.     Cloth. 

$1.00. 

In  Blue  and  Gold. 

Longfellow's  Poetical  Works.    2  vols.    $1.75. 

"  Prose  Works.     2  vols.    $1.75. 

Tennyson's  Poetical  Works.     2  vols.    $1.50. 
Whittier's  Poetical  Works.     2  vols.    $1.50. 
Leigh  Hunt's  Poetical  Works.     2  vols.    $1.50. 
Gerald  Massey's  Poetical  Works.     1  vol.    75  cents. 
Mrs.  Jameson's  Characteristics  of  Women.   75  cts. 

"  Diary  of  an  Ennuyee.    1  vol.   75  cts. 

"  Loves  of  the  Poets.     1  vol.     75  cts. 

«  Sketches  of  Art,  &c.     1  vol.     75  cts. 

"  Studies  and  Stories.     1  vol.     75  cts. 

"  Italian  Painters.     1  vol.     75  cents. 

"  Legends   of   the    Madonna.       1  vol. 

75  cents. 
Owen  Meredith's  Poems.     1  vol.     75  cents. 

•"  Lucile  :  A  Poem.     1  vol.     75  cents. 

Bowring's  Matins  and  Vespers.     1  vol.     75  cents. 
Lowell's  (J.  Russell)  Poetical  Works.  2  vols.  $1.50. 
Percival's  Poetical  Works.     2  vols.    $1.75. 
Motherwell's  Poems.     1  vol.     75  cents. 
Sydney  Dobell's  Poems.     1  vol.     75  cents. 
William  Allingham's  Poems.  1  vol.  75  cents.  In  Press. 
Horace.     Translated  by  Theodore  Martin.     1  vol.    75  cts.' 


16       A  Li§l  of  Books  Publifhed. 


Works    lately   Published. 

The  Autobiography,  Letters,  and  Literary  Re- 
mains OF  Mrs.  Thrale  Piozzi.  Edited  by  A.  Hay  ward,  Esq. 
1  vol.     $1.50. 

The  Life  and  Career  of  Major  John  Andre.  By 
Winthrop  Sargent.    1  vol.     $1.50. 

The  Sable  Cloud.  By  Nehemiah  Adams,  D.  D.,  Author 
of  "A  South-Side  View  of  Slavery."     1  vol.    75  cents. 

Faithful  Forever.  By  Coventry  Palmore,  Author  of 
"  The  Angel  in  the  House."     1  vol.    $1.00. 

Over  the  Cliffs  :  A  Novel.  By  Charlotte  Chanter, 
(a  sister  of  Rev.  Charles  Kingsley.)     1  vol.     $1.00. 

The  Recreations   of   a    Country   Parson.     1    vol. 

$1.25. 

Reminiscences   of  Scottish   Life   and   Character. 

By  Dean   Ramsay.     From  the   Seventh   Enlarged   Edinburgh 

Edition.     With  an  American  Preface.     1  vol.  16mo.     $1.00. 
Poems  by  Rev.  Wm.  Croswell,  D.  D.     Edited,  with  a 

Memoir,  by  Rev.  Arthur  Cleveland  Coxe,  D.  D.     1  vol.    $1.00. 
Personal   History  of  Lord   Bacon.    From  Original 

Letters  and  Documents.     By  Hepworth  Dixon.     1  vol.  $1.25. 
Poems.    By  Rose  Terry.     1  vol.  16mo.     75  cent^ 
The  Autobiography  of  the  Rev.  Dr.  Alexander 

Carlyle.     Containing  Memorials  of  the  Men  and  Events  of 

his  Times.    Edited  by  John  Hill  Burton. 
Favorite  Authors  :  A  Companion  Book  of  Prose  and 

Poetry.     With  26  fine  Steel  Portraits.     $2.50. 
Heroes  of   Europe.    A  capital  Boy's  Book.     With  16 

niustrations.     1  vol.  16rao.     $1.00. 
Bonnie   Scotland.    By  Grace  Greenwood.    Illustrated. 

75  cents. 
The  Seven  Little  Sisters,  who  live  in  the  Round  Ball 

that  floats  in  the  Air.    Illustrated.    63  cents. 


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